Medical Claims Processor Full-Time Opportunity Available TEKsystems is looking for someone to join a team of medical claims processors who advocate for members while maintaining the policies and procedures required. The Medical Claims Processor is responsible for adjudicating medical claims timely and accurately while providing customer service to claimants and providers. This is an in-office position where the candidate would work closely with peers and an assistant supervisor and would report to an immediate supervisor. Responsibilities will include the following Work closely with peers to ensure the goals and duties of the Claims Department are met efficiently, accurately, and pleasantly. Uphold the mindset of working together as a team. Review and analyze medical claims for eligibility and benefits. Adjudicate medical claims per the Fund’s benefit plan. Maintain knowledge of all Fund benefits. Customer Service Maintain adequate telephone coverage by communicating and working with peers’ schedules. Take calls from providers and their billing representatives. Provide eligibility and confirm benefits. Provide claim status. Assist with problems or questions and provide resources. Take calls from participants and their families. Assist with their inquiries and advocate for their healthcare needs. Ensure members receive all available benefits to which they are entitled under the plan. Contact providers or others on their behalf when needed. Work directly with vendors (medical, prescription, dental, vision, and others) to coordinate work efforts and address any issues/concerns. Comply with the Health Insurance Portability and Accountability Act (HIPAA). Adaptability and willingness to cross-train, multitask, and assist coworkers and the Fund where and when needed. Organize, prioritize, route, and ensure the resolution of matters presented to you (whether presented in person, by mail, fax, email, or otherwise).Additional Skills & Qualifications: High School graduate or GED equivalent. Minimum of one year of experience in claims processing and/or medical billing. Working knowledge of the healthcare industry, insurance claims, and the associated medical terminology. Strong customer service aptitude. Working knowledge of Microsoft Office and Adobe Acrobat products. Strong communication skillsExperience Level:Entry LevelBenefit information:
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, plans, 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)
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.
