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Claims Examiner

TEKsystems
$20.00 - $22.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, California, Fresno
Apr 23, 2025
REMOTE Claims Examiner with restrictions* will become remote after onsite training- must live within 50 miles of Fresno, CA or you will NOT work out for the role.* Description The Claims Examiner I reports to the Superviosr of Claims. Claims Examiner I is responsible for reviewing and processing medical, dental, vision and electronic claims in accordance with state, federal and health plan regulatory requirements, department guidelines, as well as meet established quality and production performance benchmarks to include research and review of applicable documentation. The incumbent will also process Health Insurance Payment Demand (HIPD) claims. The Claims Examiner I will thoroughly review, analyze, and research health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. The position will assist in resolving issues from providers, customer service, member services, health plan, and other internal customers. Additional Skills & Qualifications * High school education or equivalent: minimum one (1) to three (3) years year of experience as a Health Claims Examiner or comparable industry experience preferrecd. * A minimum of one (1)year experience as a Claims Examiner for medical, dental claims and vision, subrogation, and accident claims * Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination * Basic knowledge of medical terminology. Familiar with UB-04 and HCFA 1500 forms (837/5010 format), ICD10, CPT, and HCPCS codes. * Good verbal and written communication skills. * Proficient in 10-key by touch data entry/type 40 WPM and Microsoft Office (Word, Excel, Outlook, PowerPoint) and possess a capability to quickly learn new applications. * Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines. * Ensure compliance with all appropriate policies and practices, local, State, Federal regulations and requirements regarding claims and contract administration. Experience Level Expert Level Pay and Benefits The pay range for this position is $20.00 - $22.00/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 Apr 25, 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.