Claims Processor

Claims Analyst II Healthcare Claims Specialist Join Our Team as a Claims Analyst II!We are looking for a knowledgeable and detail-focused Claims Analyst II to support our healthcare operations team. In this role, you will evaluate, process, and resolve medical claims while ensuring compliance with benefit plans, healthcare regulations, and internal policies. The ideal candidate has experience in health insurance claims administration, strong analytical skills, and a solid understanding of medical billing and coding practices.

Key Responsibilities

• Review and process professional and institutional healthcare claims according to benefit plans and organizational guidelines.
• Evaluate claims to determine appropriate outcomes, including payment approval, denial, adjustment, or additional review.
• Verify claim accuracy, coding compliance, and supporting documentation.
• Ensure timely and accurate claim payments in accordance with established service standards.
• Research and resolve claims requiring additional review, clarification, or correction.
• Handle Coordination of Benefits (COB), Workers Compensation, and subrogation-related claims.
• Identify processing discrepancies and make appropriate system updates or claim adjustments.
• Review high-dollar claims and authorize payments within designated authority levels.
• Apply contractual reimbursement methodologies and network discounts during claim review.
• Communicate with providers, members, and internal departments to obtain required information and resolve claim issues.
• Maintain complete and accurate records of claim decisions, adjustments, and payment activities.
• Process specialized claims, including transplant and complex reimbursement cases.
• Meet departmental productivity, quality, and turnaround-time expectations.
• Stay informed on changes to benefit plans, provider contracts, medical policies, and regulatory requirements.

Required Qualifications

• High school diploma, GED, or equivalent combination of education and experience.
• Minimum 2-4 years of experience in healthcare claims processing or claims administration.
• Experience reviewing and adjudicating both professional and facility medical claims.
• Working knowledge of healthcare reimbursement practices and claims payment methodologies.
• Strong understanding of:
• Medical terminology
• CPT, ICD-9, and ICD-10 coding
• Coordination of Benefits (COB)
• Subrogation procedures
• Healthcare claims regulations and guidelines
• Ability to interpret insurance plan documents, certificates of coverage, and medical policies.
• Excellent analytical, organizational, and problem-solving abilities.
• Proficiency using healthcare claims processing platforms and related software applications.

Preferred Qualifications

• Experience working with QNXT or similar healthcare claims systems.
• Background supporting Medicaid, ACA, Managed Care, Medicare, or commercial health plans.
• Medical coding experience and/or industry certifications.
• Knowledge of provider reimbursement methodologies, fee schedules, discounts, and claim repricing processes.
• Experience handling complex claim reviews and payment investigations.

Why Join Us?

• Opportunity to work within a dynamic healthcare insurance environment.
• Collaborative team culture focused on quality and service excellence.
• Professional growth and development opportunities.
• Meaningful work that contributes to positive member and provider experiences.

If you have a passion for healthcare operations, claims accuracy, and delivering exceptional service, we encourage you to apply today!Job Type & LocationThis is a Contract to Hire position based out of Appleton, WI. Pay and BenefitsThe pay range for this position is $19.25 - $19.25/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.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) Job Type & LocationThis is a Contract to Hire position based out of Appleton, WI. Application DeadlineThis position is anticipated to close on Nov 3, 2026. Workplace TypeThis is a fully remote position.

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

Were 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. Were 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. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were 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.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.