About the Opportunity

We are seeking a detail-oriented Claims Analyst II to join our growing team. In this role, you will review, analyze, and process medical claims while ensuring accuracy, compliance, and adherence to established health plan policies and procedures. This position offers the flexibility of working remotely within Wisconsin, onsite, or in a hybrid environment.

If you have experience processing medical claims and enjoy investigating, problem-solving, and ensuring members receive accurate claim determinations, we encourage you to apply.

What You'll Do

• Process professional and facility medical claims for payment according to plan benefits, medical policies, and coverage guidelines.
• Review claims for completeness, accuracy, and compliance with billing standards.
• Determine whether claims should be paid, denied, returned, or pended based on established guidelines.
• Investigate and resolve pending claims within established timeframes.
• Identify and process Coordination of Benefits (COB), Workers' Compensation, and subrogation claims.
• Monitor claims processing systems and correct errors or discrepancies as needed.
• Process specialty claims, including transplant, COB, and other complex claim types.
• Review claims for repricing and apply appropriate network discounts.
• Document claim decisions and maintain accurate records.
• Meet department quality and productivity standards while maintaining confidentiality.
• Stay current on benefit plans, provider agreements, medical policies, and claims processing regulations.

Required Qualifications

• 2-4 years of medical claims processing experience
• Knowledge of:
• CPT coding
• ICD-9 and ICD-10 coding
• Medical terminology
• Coordination of Benefits (COB)
• Subrogation processes
• Strong analytical, organizational, and problem-solving skills
• Ability to work independently while maintaining accuracy and productivity
• High attention to detail and commitment to quality

Why Join Us?

• Flexible work environment with remote, hybrid, or onsite options
• Stable Monday-Friday schedule
• Comprehensive virtual training program
• Opportunity to contribute to a growing organization supporting members and providers
• Collaborative team environment focused on quality and customer service

Training & Schedule

First 6 weeks of training: 8:00 AM - 4:30 PM. After training, employees may work with their supervisor regarding scheduling flexibility. Standard operating hours are between 8:00 AM and 5:00 PM, Monday through Friday.

Apply Today

If you have experience processing medical claims and are looking for an opportunity with flexibility, growth potential, and a strong team culture, we'd love to hear from you!

Job Type & Location

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

Pay and Benefits

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)

Application Deadline

This position is anticipated to close on Nov 4, 2026.

Workplace Type

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.