Claims Analyst (Medical Claims Processing)

Location: Remote within Wisconsin (must be able to pick up equipment from the Menasha or Brookfield office)

Job Type: Contract-to-Hire

Schedule: Full-Time, 40 hours/week, Monday-Friday

Training Schedule: 8:00 AM - 4:30 PM for the first 6 weeks (virtual training)

Pay Rate: $19.25/hour

Overview

We are seeking an experienced Claims Analyst to join a growing healthcare operations team. This position is responsible for reviewing, analyzing, and adjudicating medical claims while ensuring compliance with benefit plans, medical policies, and established processing guidelines. The ideal candidate will have prior medical claims processing experience, strong attention to detail, and the ability to work efficiently in a production-driven environment.

Key Responsibilities

• Review and adjudicate paper and electronic medical claims.
• Determine whether claims should be approved, denied, pended, suspended, or returned for additional information.
• Process professional and facility claims in accordance with benefit plans and medical policies.
• Verify claim accuracy, coding, billing standards, and completeness of documentation.
• Investigate and resolve pending claims within established turnaround times.
• Identify and process Coordination of Benefits (COB), Workers' Compensation, and subrogation-related claims.
• Monitor claims processing systems for errors and make necessary corrections.
• Apply provider discounts, pricing adjustments, and contract-specific reimbursement methodologies.
• Process specialty claims, including transplant and COB claims.
• Maintain accurate documentation and claim notes.
• Meet established productivity, quality, and accuracy standards.
• Collaborate with internal teams to resolve claim issues and support operational goals.

Required Qualifications

• 2-4 years of medical claims processing experience.
• Experience adjudicating professional and facility medical claims.
• Knowledge of CPT, ICD-9, and ICD-10 coding.
• Familiarity with medical terminology and healthcare claims processes.
• Experience with Coordination of Benefits (COB) and subrogation.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.
• Ability to meet productivity and quality metrics in a high-volume environment.
• Strong written and verbal communication skills.

Preferred Qualifications

• Experience with QNXT Claims Workflow.
• Experience supporting ACA, Medicaid, or other health plan environments.
• Medical coding experience.
• Experience with claims repricing and network reimbursement methodologies.
• Knowledge of provider contracts, benefit plans, and utilization management processes.

Work Environment

This role offers flexibility with remote work for candidates residing in Wisconsin. Employees may work remotely, onsite, or in a hybrid capacity. Reliable internet access is required, and candidates must be able to pick up company equipment from the Menasha or Brookfield office.

What We're Looking For

Successful candidates are detail-oriented professionals who thrive in a fast-paced claims environment, can interpret complex healthcare policies and billing information, and consistently maintain high levels of accuracy while meeting performance expectations.

Apply today if you have medical claims processing experience and are looking for an opportunity to grow with a healthcare organization that values quality, accuracy, and operational excellence.

#centralpriority26

This is a Contract to Hire position based out of Waukesha, WI.

The 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)

This is a Contract to Hire position based out of Waukesha, WI.

This position is anticipated to close on Nov 12, 2026.

This 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.