Position Overview: We are seeking a meticulous and experienced Claims Examiner to join our Supplemental Health team. The Claims Examiner is responsible for accurate and timely adjudication of complex professional, facility, and ancillary claims. This role makes timely, accurate, and customer-focused claim decisions

for supplemental health products that may include limited benefit medical (LBM), critical illness, hospital indemnity, scheduled or group accident, and/or minimum essential coverage (MEC) products.

Qualifications:

Minimum of 2 years of experience in handling Hospital Indemnity claims.

2+ years of experience as Claims Adjudicator or claims examiner.

Preferred experience with medical accident claims critical Illness claims.

Strong analytical and problem-solving skills.

Excellent written and verbal communication skills.

High attention to detail and organizational skills.

Key Responsibilities:

Make timely, accurate, and customer-focused claim decisions.

Reach out to obtain relevant information from multiple sources as needed on a claim-by-claim basis. This analysis may include making contact with healthcare providers, processing coordination of benefits (COB) claims, and adjudicating group benefits for one claimant with multiple lines of coverage.

Compare the information received to the terms, limitations, and conditions of the contract and applicable procedural documents and render the claim decision as quickly as possible.

Document the claim systems in an accurate and comprehensive manner while maintaining maximum levels of efficiency.

Prepare and disseminate articulate written and verbal communication to assorted internal and external sources.

Prepare, update, and utilize a claim management plan to attain the most appropriate outcome.

Remain in full compliance with regulatory requirements.

Demonstrate proficiency in the supplemental health products and claim administration techniques.

Details:

100% remote – must be comfortable working PST schedule. Equipment is provided

Pay: $25 - $27/hr. based on related experience

Pay cycle – weekly | medical, dental, vision benefits offered.

Schedule: Monday – Friday | 8:30am – 5:00pm (PST)

Pay and Benefits

The pay range for this position is $25.00 - $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 ADD 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 Feb 28, 2025.

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.