Medicare Claims Processor (Remote To Wisconsin Only)

Position Overview We are seeking a Claims Analyst II to examine and process both paper and electronic healthcare claims. In this role, you will determine whether claims should be returned, pended, denied, or paid in accordance with established policies, procedures, and benefit plans. This position plays a critical role in ensuring accurate, timely claim adjudication while maintaining confidentiality and quality standards.

• Must be able to pick up equipment from either our Menasha or Brookfield office.
• Fully Remote (Wisconsin Residents Only)
• Schedule: Full‑time (40 hours/week)

Primary Responsibilities

• Adjudicate professional and facility claims in accordance with member Certificates of Coverage, medical policies, and plan benefits.
• Review claims for accuracy, proper billing standards, and completeness of information.
• Determine appropriate claim disposition (pay, deny, pend, or return) within established timeframes.
• Obtain additional or missing information from providers, members, or internal partners as needed.
• Maintain department quality standards and required turnaround times.
• Identify and process Coordination of Benefits (COB), Workers’ Compensation, and Subrogation claims.
• Investigate and resolve pending claims; deny claims when resolution timelines are exceeded.
• Monitor claims processing systems for errors and make necessary corrections or adjustments.
• Review claims for re‑pricing and apply internal or external provider discounts as appropriate.
• Review home office claims for payment up to $18,000.
• Process specialty claims (e.g., transplant, URN, COB) according to external contract requirements.
• Accurately document claim decisions, attributes, and memos.
• Stay current on group contracts, provider discounts, authorizations, and utilization management policies.
• Perform additional duties as assigned.

Required Qualifications

• 2–4 years of healthcare claims processing experience
• Knowledge of:
• Medical terminology
• CPT and ICD‑9/ICD‑10 coding
• Coordination of Benefits (COB), subrogation
• Ability to manage confidential information with accuracy and professionalism
• Strong attention to detail and time‑management skills

Preferred Experience

• Medicaid or ACA plan experience
• Claims adjudication experience
• Coding experience
• Prior experience with QNXT™ Claims Workflow

Education

• High school diploma or equivalent preferred

Work Environment & Location

• Must reside in Wisconsin
• Eligible to work:
• Fully remote (home office requires reliable internet)
• Menasha office
• Brookfield office
• Hybrid model
• Equipment must be picked up in Menasha or Brookfield

Training & Schedule

• Training schedule: 8:00am – 4:30pm, Monday–Friday for the first 6 weeks (virtual training)
• Post‑training schedule may be adjusted in consultation with supervisor
• Regular business hours fall between 8:00am – 5:00pm, Monday–Friday

Why Join Us?

• Internal career growth opportunities across departments
• Fully remote work option within Wisconsin
• Stable, full‑time role supporting seasonal business needs and growth

Job Type & Location This is a Contract to Hire position based out of Menasha, WI. Pay and Benefits The 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 Type This is a fully remote position. Application Deadline This 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. Apply tot his job Apply To this Job