Remote Medical Claims Jobs in Appleton, WI (NOW HIRING)

Are you detail-oriented, analytical, and passionate about delivering accurate results? We are seeking a Claims Analyst to review and process both paper and electronic claims while ensuring compliance with established policies, procedures, and benefit guidelines. In this role, you will evaluate claims, determine appropriate actions, and help ensure timely and accurate claim resolution.

• Review, analyze, and adjudicate professional and facility claims in accordance with benefit plans, medical policies, and established procedures.
• Determine whether claims should be approved, denied, returned, suspended, or pended based on policy guidelines and supporting documentation.
• Verify claim accuracy, completeness, and compliance with billing standards.
• Research and gather additional information from providers, members, or other sources when necessary to support claim processing.
• Process approved claims for payment while maintaining confidentiality and data integrity.
• Investigate and resolve pending claims within established service level timeframes.
• Identify and appropriately handle Coordination of Benefits (COB), Workers' Compensation, and Subrogation-related claims.
• Monitor claims processing systems for errors and make necessary corrections or adjustments.
• Apply contract terms, provider discounts, reimbursement methodologies, and benefit interpretations accurately during claim adjudication.
• Review and process claims requiring specialized pricing, including transplant, network repricing, and COB claims.
• Enter claim data into appropriate repricing systems and apply internal or external discount arrangements as needed.
• Maintain thorough and accurate documentation related to claim decisions and payment activities.
• Meet established productivity, turnaround time, and quality standards.
• Stay current on policy updates, benefit changes, provider agreements, and reimbursement guidelines.
• Perform additional duties and special projects as assigned.

• Strong analytical skills and attention to detail.
• Ability to interpret policies, procedures, contracts, and benefit plans.
• Experience processing or adjudicating healthcare claims preferred.
• Strong problem-solving and research abilities.
• Proficiency with claims processing systems and computer applications.
• Ability to manage confidential information with professionalism and discretion.
• Excellent organizational skills with the ability to meet productivity and quality goals in a fast-paced environment.

This position is ideal for individuals who enjoy investigating complex issues, maintaining high levels of accuracy, and contributing to a positive member and provider experience.

Job Type & Location

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

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)

This is a fully remote position.

This position is anticipated to close on Aug 31, 2026.

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.

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.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.