[Hiring] Medical Claims Processor @TEKsystems
Role Description
- This role involves processing medical claims and ensuring compliance with policy guidelines.
- Deny inappropriate claims following policy guidelines.
- Prepare claims that must be routed to other departments for further review.
- Review difficult claims with guidance from Claims Supervisor.
- Identify billing errors and possible fraudulent claims submissions.
- Obtain eligibility verification and other health insurance coverage by Internet or POS.
- Perform correct manual calculation of benefits when applicable.
- Identify possible CCS eligible claims for further investigation.
- Report overpayment refund requests on SharePoint log.
- Maintain productivity and quality in accordance with established guidelines.
- Perform other job-related duties as required.
- Regular predictable attendance.
- Adhere to all company policies and procedures relative to employment and job responsibilities.
- Qualifications
- High School Diploma from an accredited school or equivalent.
- Minimum of one (1) year medical Claims Examiner processing experience.
- Good organizational skills and the ability to make good decisions.
- Experience with QNXT.
- Experience with Medi-Cal Claims.
- Requirements
- This is a Contract to Hire position based out of Bakersfield, CA.
- The pay range for this position is $22.00 - $22.00/hr.
- Benefits
- 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 7, 2026.
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