REMOTE Claims Examiner
Professional Summary Detail-oriented and highly organized claims specialist with expertise in D-SNP (Dual Eligible Special Needs Plan) claims processing. Skilled in researching, correcting, and resolving pended claims, ensuring compliance with regulatory guidelines, and maintaining accurate documentation. Adept at working in high-volume environments with strong attention to detail and excellent communication skills. Core Responsibilities
- Research, correct, and respond to all D-SNP pended claims in a timely manner.
- Review audit reports and determine claim payment eligibility in accordance with policies and procedures.
- Maintain accurate correspondence and documentation for medical procedures, CPT, and HCFA codes.
- Review, price, and release claims for assigned claim types (paper and electronic).
- Analyze Manual Review reports for suspended D-SNP claims.
- Stay current on all D-SNP policies and contribute to departmental improvement projects.
- Ensure compliance with all regulatory guidelines and monitor adherence.
- Maintain daily activity logs and assist with claims processing.
- Perform additional duties and special projects as assigned.
Skills
- Claims Processing
- Project Management
- Healthcare Operations
- Workflow Optimization
- Medical Terminology & Coding
Technical Skills
- QNXT platform proficiency
- Strong knowledge of D-SNP program
- Expertise in dual eligible claims processing (Medi-Cal and Medicare D-SNP)
Qualifications
- Prior experience in high-volume production environments
- Excellent oral and written communication skills
- Strong attention to detail
- Medical terminology and/or coding experience highly desirable
Experience Level Entry Level Job Type & Location This is a Contract position based out of Santa Barbara, CA. Pay And Benefits The pay range for this position is $24.00 - $27.00/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 Jan 21, 2026. 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. Apply To this Job