[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.