New

Claims Analyst - Work From Home - Must Reside In WI

TEKsystems
$19.25 / hr
life insurance, sick time, 401(k), retirement plan
United States, Wisconsin, Menasha
Mar 25, 2026
Job Description We are seeking a Claims Analyst II to review, analyze, and process paper and electronic professional and facility claims. In this role, you will determine whether claims should be paid, denied, pended, or returned in accordance with established policies, procedures, and benefit provisions. The ideal candidate demonstrates strong attention to detail, sound judgment, and the ability to meet quality and productivity standards. Key Responsibilities: * Adjudicate professional and facility claims in accordance with members' Certificates of Coverage, medical policies, plan benefits, operating memos, and corporate guidelines. * Review claims for accuracy, completeness, and compliance with proper billing standards. * Compare claims, provider documentation, and system records to ensure validity and completeness. * Determine appropriate claim disposition (pay, pend, deny, or return) and process approved payments. * Identify and adjudicate claims involving Coordination of Benefits (COB), Workers' Compensation, and Subrogation. * Obtain additional information from providers, members, or other sources as needed to resolve claims. * Investigate and resolve pending claims within established timeframes; pend, suspend, or deny claims when appropriate. * Monitor claims processing systems for errors and make corrections or adjustments as needed. * Maintain departmental quality, confidentiality, turnaround time, and individual productivity standards. * Stay current on group contracts, provider agreements, discounts, per diems, authorizations, and utilization management policies. * Review and approve home office claims for payment up to $18,000. * Re-price claims by entering eligible data into re-pricing systems; apply internal and external discounts as appropriate. * Process specialty claims (e.g., transplant, URN, COB) according to applicable external contracts. * Document claim attributes, notes, and memos accurately and thoroughly. * Perform other related duties as assigned. Main Position Details: Start: 4/20 Pay: $19.25/Hr Training: 6 weeks in length Monday - Friday from 8:00am - 4:30pm Schedule: Monday - Friday 8:00am - 5:00pm Location: Remote in Wisconsin. Must be able to pick up equipment from local office. Duration: 3 Month Contract to Hire position Qualifications: * High school diploma or equivalent preferred. * 2-4 years claims processing experience required * Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation. * Past experience using QNXT Claims Workflow a plus * Prior experience with ACA, Medicaid, or similar health plans preferred. * Coding experience preferred. #centralpriority26 Job Type & LocationThis 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 Mar 31, 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.