New 
Remote Medical Claims Examiner
 TEKsystems | |
$23.00 - $25.00 / hr
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medical insurance, life insurance, sick time, 401(k), retirement plan
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 United States, California, Bakersfield | |
 Mar 25, 2025 | |
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*Remote Medical Claims Examiner*
*This role will be working fully remote! This role involves reviewing, analyzing, and adjudicating claims to ensure compliance with applicable policies, procedures, and regulations* *You'll enjoy* *Competitive Pay* *Opportunity to work for a large health care company* * * *A day in the role...* * Review and process healthcare claims in accordance with company policies, contractual provisions, and regulatory guidelines. * Validate information on claim forms, including patient details, provider information, and service codes. * Ensure accurate application of CPT, ICD-10, and HCPCS codes. * Determine eligibility, coverage, and medical necessity of services provided. * Analyze and adjudicate complex claims, including high-dollar and specialty claims. * Identify discrepancies or inconsistencies and take appropriate corrective actions. * Apply appropriate modifiers and ensure proper coding for accurate claim payment. * Coordinate with the medical review team for cases requiring clinical evaluation. * Maintain up-to-date knowledge of state and federal regulations, payer policies, and industry standards. *Necessary Skills and Strengths:* *Health Plan Knowledge| Claims Processing | Medical Insurance* *Core Experience:* * 2+ years of QNXT claims processing experience required * Experience with Medi-Cal and Medicare a plus *Experience Level* Expert Level #westpriority25 *Pay and Benefits* The pay range for this position is $23.00 - $25.00/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 Mar 28, 2025. 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. | |