[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.
Apply tot his job
Apply To this Job
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.
Apply tot his job
Apply To this Job