New

Medical Claims Examiner (Fully Remote After Training)

TEKsystems
$21.00 - $24.00 / hr
life insurance, sick time, 401(k), retirement plan, remote work
United States, California, Fresno
Aug 21, 2025
Job Title: Claims Examiner Location: Fresno, CA (On-site training required; 100% remote after training) Overview Our client is seeking a Claims Examiner to join their growing team. This role is ideal for someone with a strong background in claims processing, attention to detail, and a commitment to quality assurance. The position involves adjudicating a variety of claim types, ensuring compliance with regulatory standards, and supporting internal and external stakeholders. Key Responsibilities * Adjudicate medical, dental, vision, and electronic claims including inpatient/outpatient, in-network/out-of-network, Medicaid reclamation (HIPD), and Third-Party Liability (TPL). * Analyze patient and medical data to determine appropriate benefits, pricing, and prior authorizations. * Verify claim accuracy and eligibility; communicate with healthcare providers to obtain necessary documentation. * Resolve benefit and eligibility issues in accordance with ERISA and company guidelines. * Maintain HIPAA-compliant work practices and secure handling of confidential data. * Meet departmental productivity and quality standards. * Process low-level claims, re-pricing corrections, and respond to correspondence related to electronic and paper claims. Required Qualifications * High school diploma or equivalent. * 1-3 years of experience as a Health Claims Examiner or in a related role. * Experience with medical, dental, vision, subrogation, and accident claims. * Familiarity with UB-04, HCFA 1500 forms, ICD-10, CPT, and HCPCS codes. * Ability to interpret Summary Plan Descriptions (SPD) for accurate adjudication. * Strong verbal and written communication skills. * Proficient in Microsoft Office and 10-key data entry (40 WPM). * Knowledge of ERISA claims processing guidelines. Preferred Skills * Basic medical terminology knowledge. * Strong problem-solving and decision-making abilities. * Ability to work under pressure and adapt to a changing environment. Employee Value Proposition * 100% Remote Work after completion of on-site training. * Supportive Training Environment in Fresno office. * Collaborative Team Culture with strong peer support. Work Environment * Initial training will be conducted on-site in Fresno, CA. * Post-training, the position transitions to fully remote. * Flexible scheduling and a team-oriented atmosphere. #westpriority25 Pay and Benefits The pay range for this position is $21.00 - $24.00/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 Aug 29, 2025. h4>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. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.