Job Details

Claims Analyst II

We're looking for a detail-oriented Claims Analyst II to join our growing team! In this role, you'll review and process paper and electronic claims, ensuring accuracy and compliance with policies and procedures. You'll play a key part in adjudicating claims and resolving issues to deliver excellent service to our members. Schedule: Full-time, MondayFriday, 8:00 AM5:00 PM.

What You'll Do:

• Adjudicate claims following departmental policies and corporate guidelines.
• Process professional and facility claims in accordance with plan benefits and medical policies.
• Review claims for completeness and proper billing standards.
• Obtain additional information from providers or agencies as needed.
• Maintain quality and turnaround standards while meeting production goals.
• Identify and resolve coordination of benefits (COB), Workers' Compensation, and Subrogation issues.
• Investigate pending claims and take appropriate action within established time frames.
• Monitor and correct claims processing errors in the system.
• Stay current on contracts, provider discounts, and utilization management policies.
• Review and process specialty claims (e.g., transplant, COB) and claims up to $18,000.
• Document claim details accurately and maintain confidentiality.
• Perform other duties as assigned.

What We're Looking For:

• High school diploma or equivalent (preferred).
• 2+ years of claims processing experience required.
• Knowledge of CPT, ICD-9/ICD-10 coding, medical terminology, COB, and subrogation.
• Experience with QNXT Claims Workflow a plus.
• Familiarity with ACA, Medicaid, or similar health plans preferred.
• Coding experience is a bonus.

Work Environment:

• Candidates must reside in Wisconsin.
• Flexible work options: remote (with reliable internet), in-office (Menasha or Brookfield), or hybrid.
• Training schedule: 8:00 AM4:30 PM for the first 6 weeks (virtual training), then flexible scheduling with supervisor.

Why Join Us?

• Be part of an expanding claims team driven by growth.
• Enjoy a collaborative and supportive work environment.
• Competitive starting pay and opportunities for development.

Job Type & Location:

This is a Contract to Hire position based out of Brookfield, WI. Pay and Benefits The pay range for this position is $19.25 - $19.25/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)

Application Deadline:

This position is anticipated to close on Dec 18, 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.