[Remote] Claims Examiner- FULLY REMOTE!

Note: The job is a remote job and is open to candidates in USA. TEKsystems is a leading provider of business and technology services, and they are seeking a Claims Examiner for a fully remote contract position. The role involves reviewing claims documentation for accuracy and completeness, assessing claim validity, calculating benefit amounts, communicating with stakeholders, and maintaining organized records.

Responsibilities

• Examine submitted claims for completeness, accuracy, and compliance with policy terms.
• Verify supporting documents such as medical records, police reports, or receipts.
• Assess whether claims meet criteria for approval based on policy coverage.
• Investigate potential fraud, inconsistencies, or discrepancies.
• Determine appropriate payout amounts based on policy limits and deductibles.
• Ensure all calculations are accurate, justified, and documented.
• Contact claimants, healthcare providers, or other relevant parties to gather additional information.
• Provide timely updates and clear explanations regarding claim decisions.
• Document all actions taken during the claim review process.
• Ensure records are organized and compliant with regulatory and company standards.
• Partner with adjusters, underwriters, and legal teams as needed.
• Refer complex or high-risk cases for further investigation or legal review. Skills
• 1-3 years of recent medical claims experience or something related
• Ability to communicate effectively and professionally with personnel, in both written and verbal form
• Must possess a strong attention to detail and an interest in preventing errors
• Ability to operate a personal computer (PC) and other office equipment (e.g., copy machine, fax machine, printer, calculator, etc.) as well as possess excellent keyboarding skills
• Demonstrate ability to be dependable and professional
• Demonstrate intrinsic initiative and time management skills
• Must possess a strong commitment to teamwork and an ability to foster an inclusive culture of diversity by working well and collaborating with others as needed
• Ability to accept feedback, learn, and adapt from guidance to be successful
• Ability to adapt to consistently changing priorities and keep daily responsibilities on task
• Ability to manage workload and ensure all tasks are completed within established timeframes
• Must be willing and able to work possible mandatory overtime as needed based on business needs
• Must be able to meet quality, productivity, and behavior expectations
• Must possess basic reading and arithmetic skills (reading and math comprehension)
• Customer service
• Healthcare industry
• Claims processing
• Medical billing
• Claims analysis 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) Company Overview
• At TEKsystems, they understand people. Every year they deploy over 80,000 IT professionals at 6,000 client sites across North America, It was founded in 1994, and is headquartered in Hanover, Maryland, USA, with a workforce of 10001+ employees. Its website is Apply tot his job Apply tot his job Apply tot his job

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