Claims Processor

Claims Processor I Location: Fresno, CA Work Arrangement: Remote after successful completion of onsite training Overview We are seeking a detail-oriented Claims Processor I to join a growing healthcare organization. This role is responsible for reviewing, analyzing, and processing medical, dental, and vision claims while ensuring accuracy, compliance, and adherence to established production and quality standards. The ideal candidate will have experience in claims adjudication, medical terminology, and healthcare billing processes. Key Responsibilities Review and adjudicate medical, dental, and vision claims in accordance with health plan guidelines and regulatory requirements. Process inpatient, outpatient, physician, laboratory, radiology, accident, third-party liability (TPL), and Medicaid reclamation claims. Analyze claim information to determine eligibility, benefits, pricing, prior authorization requirements, and coordination of benefits. Research and resolve claim discrepancies using applicable documentation and plan guidelines. Verify eligibility, authorizations, and supporting documentation to ensure accurate claim processing. Contact healthcare providers as needed to obtain additional claim information. Process Health Insurance Payment Demand (HIPD) claims. Respond to inquiries from providers, customer service teams, member services, and internal departments. Research and resolve correspondence related to paper and electronic claims. Maintain compliance with HIPAA regulations and confidentiality requirements. Meet established productivity, quality, and turnaround time standards. Required Qualifications High school diploma or equivalent. 1-3 years of healthcare claims processing experience or related industry experience. At least 1 year of experience processing medical, dental, and vision claims. Knowledge of claims adjudication and benefits determination. Understanding of medical terminology and healthcare billing concepts. Experience with UB-04, HCFA/CMS-1500 forms, ICD-10, CPT, and HCPCS coding. Strong analytical, problem-solving, and decision-making skills. Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, and PowerPoint. Strong data entry skills with the ability to accurately manage high-volume workloads. Excellent written and verbal communication skills. Ability to work independently in a fast-paced environment while maintaining quality standards. Preferred Qualifications Medical Billing Certification. Medical Coding Certification. Knowledge of ERISA claims processing guidelines. Experience processing subrogation, accident, or third-party liability claims. Experience working with CMS-1500 and HCFA claim forms. Work Environment Remote position following successful completion of training. Initial training will be conducted onsite in Fresno, California. Remote work eligibility begins after achieving required production and quality standards. Collaborative team environment with ongoing support and development. What You'll Gain Opportunity to work remotely after training. Comprehensive onboarding and training support. Collaborative team culture focused on quality and professional growth. Opportunity to expand expertise in healthcare claims processing and adjudication. Pay and Benefits The pay range for this position is $20.00 - $22.00/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) Employment Type This is a Contract position based out of Fresno, CA. Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Aug 4, 2026. 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. 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. #J-18808-Ljbffr TEKsystems