New

Claims Analyst

TEKsystems
$19.25 / hr
life insurance, sick time, 401(k), retirement plan
United States, Wisconsin, Menasha
Mar 24, 2026
Claims Analyst II (Fully Remote - Wisconsin) Position Overview We are seeking a detail-oriented Claims Analyst II to examine, adjudicate, and process professional and facility medical claims in accordance with established policies, procedures, and regulatory requirements. This role is responsible for ensuring accurate, timely, and compliant claims processing while maintaining confidentiality and quality standards. The Claims Analyst II plays a critical role in resolving complex claims issues, identifying coordination of benefits (COB) and subrogation opportunities, and ensuring claims are processed in alignment with member benefits, provider contracts, and internal guidelines. Key Responsibilities Claims Adjudication & Processing * Examine and adjudicate paper and electronic professional and facility claims by determining whether claims should be paid, denied, pended, or returned in accordance with: * Member Certificates of Coverage * Medical policies and procedures * Corporate guidelines and operating memos * Process approved claims accurately and timely, including payments up to $18,000 in accordance with authority levels. * Ensure claims comply with proper billing standards, coding requirements, and completeness of documentation. * Review claims for re-pricing and apply internal or external discounts, provider contracts, per diems, and fee schedules as appropriate. * Enter eligible claims into WRAP network re-pricing systems and override allowed amounts when necessary. Claims Resolution & Investigation * Investigate and resolve pending claims within established timeframes. * Identify claims requiring pended or suspended status and follow up to resolution. * Deny claims appropriately when required information is not received within established guidelines. * Obtain additional information from providers, members, employers, or external agencies as needed. * Resolve claims and related issues in compliance with policy provisions and regulatory standards. Specialized Claims & Compliance * Identify and adjudicate claims involving: * Coordination of Benefits (COB) * Workers' Compensation * Subrogation * Specialty claims including Transplant, URN, and COB pricing * Apply appropriate pricing methodologies based on external contracts and benefit interpretation. * Monitor claims processing systems for errors and make necessary corrections or adjustments. * Maintain current knowledge of: * Group contracts and enrollee certificates * Provider agreements and discounts * Authorizations and utilization management policies * Medical coding updates and regulatory changes Quality, Productivity & Documentation * Maintain departmental quality standards and established turnaround time requirements. * Meet or exceed individual productivity and accuracy benchmarks. * Appropriately document claim attributes, notes, and memos to support claim determinations and audits. * Protect confidential and sensitive member and provider information in accordance with HIPAA and company policies. Additional Responsibilities * Collaborate with team members, supervisors, and other departments to resolve escalated or complex claims issues. * Participate in training and ongoing education to remain current with systems, policies, and procedures. * Perform other duties and responsibilities as assigned. Required Skills & Qualifications * High school diploma or equivalent (preferred) * 2-4 years of medical claims processing experience required * Working knowledge of: * Current Procedural Terminology (CPT) * ICD-9 and ICD-10 diagnosis codes * Medical terminology * Coordination of Benefits (COB) * Subrogation processes * Strong attention to detail with the ability to interpret benefits and contracts accurately * Ability to manage multiple priorities while meeting productivity and quality standards * Proficiency with claims processing systems; QNXT Claims Workflow experience a plus * Prior experience with ACA, Medicaid, or similar health plans preferred * Medical coding experience preferred Job Type & Location This is a Contract to Hire position based out of Menasha, WI. Pay and BenefitsThe pay range for this position is $19.25 - $19.25/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace TypeThis is a fully remote position. Application DeadlineThis position is anticipated to close on Apr 6, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.