REMOTE Medical Claims Representative

<h2><strong>Remote Customer Service Representative – Medical Claims (Contract‑to‑Hire)</strong></h2><p><strong>Preferred Time Zones:</strong> Mountain or Pacific<p>Candidates in Central or Eastern Time Zone <strong>must</strong> have experience working a later shift.<p><strong>Schedule:</strong></p><ul><li>Monday–Friday</li><li><strong>8:30 AM – 5:00 PM Pacific Time</strong> <em>or</em> <strong>9:30 AM – 6:00 PM Mountain Time</strong></li><li><strong>Candidates in CST/EST must be comfortable working 11:30 AM – 8:00 PM EST</strong></li></ul><hr /><h3><strong>Position Overview</strong></h3><p>The Remote Customer Service Representative (CSR) provides timely, accurate, and customer‑focused benefit and claim support for a variety of supplemental health insurance products. These products include SB Medical, Accident, Critical Illness, Hospital Indemnity, Prescription, Dental, Vision, and MEC plans.<p>This role is heavily focused on <strong>claims intake and customer support</strong>, requiring strong medical claims knowledge, high attention to detail, and the ability to manage a high call volume in a remote call‑centre environment.</p><hr /><h3><strong>Key Responsibilities</strong></h3><p><strong>Customer Service & Call Handling (80%)</strong></p><ul><li>Handle an average of <strong>40–50 inbound customer service calls per day</strong></li><li><strong>Provide clear, accurate information regarding benefits, claims status, and coverage</strong></li><li><strong>Collect and enter all required claim information accurately and efficiently</strong></li><li><strong>Document detailed call summaries in the claims system ensuring clarity and accuracy</strong></li><li><strong>Issue timely and accurate claim acknowledgement correspondence</strong></li><li><strong>Process incoming documentation with high coding integrity and route appropriately</strong></li></ul><p><strong>Claims Registration (15%)</strong></p><ul><li>Accurately register and enter incoming medical claims</li><li>Meet or exceed productivity and quality metrics</li><li>Process approximately <strong>20 claims per day</strong></li></ul><p><strong>Additional Duties (5%)</strong></p><ul><li>Perform other tasks or projects as assigned by management</li></ul><hr /><h3><strong>Required Qualifications (Must Haves)</strong></h3><ul><li><strong>1–2+ years of experience</strong> working with <strong>health insurance claims and benefits</strong>, specifically:<ul><li>Scheduled Accident</li><li>Critical Illness</li><li>Hospital Indemnity</li></ul></li><li><strong>Medical claims processing experience</strong> involving:<ul><li>Doctor visits</li><li>Diagnostic testing</li><li>Hospital stays</li></ul></li><li>Strong knowledge of <strong>CPT, HCPCS, Revenue Codes, and ICD‑10</strong></li><li><strong>Hands‑on experience reading and interpreting:</strong><ul><li><strong>HCFA 1500</strong></li><li><strong>UB‑04</strong></li></ul></li><li>Ability to review and understand <strong>medical records and Explanation of Benefits (EOBs)</strong></li><li><strong>1+ year of call centre experience</strong> (remote experience strongly preferred)</li><li>Comfortable working in a <strong>high‑volume, metric‑driven environment</strong></li></ul><hr /><h3><strong>Skills & Knowledge</strong></h3><ul><li>Medical Claims Processing</li><li>Health Insurance & Supplemental Benefits</li><li>Customer Service (Call Centre)</li><li>Claims Intake & Registration</li><li>Medical Billing & Revenue Cycle</li><li>Appeals & Denials</li><li>CPT / ICD‑10 Coding</li><li>HCFA 1500 & UB‑04 Forms</li></ul><hr /><h3><strong>Experience Level</strong></h3><p><strong>Expert Level</strong></p><hr /><h3><strong>Job Type & Location</strong></h3><ul><li><strong>Contract‑to‑Hire</strong></li><li><strong>Remote position</strong></li><li><strong>Project based out of El Paso, TX</strong></li></ul><p><strong>Job Type & Location</strong><p>This is a Contract to Hire position based out of Raleigh, NC.</p><strong>Pay and Benefits</strong><p>The pay range for this position is $21.00 - $23.00/hr.<p>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: <br /><span style="margin-left:10px;">• </span> Medical, dental & vision <br /><span style="margin-left:10px;">• </span> Critical Illness, Accident, and Hospital <br /><span style="margin-left:10px;">• </span> 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available <br /><span style="margin-left:10px;">• </span> Life Insurance (Voluntary Life & AD&D for the employee and dependents) <br /><span style="margin-left:10px;">• </span> Short and long-term disability <br /><span style="margin-left:10px;">• </span> Health Spending Account (HSA) <br /><span style="margin-left:10px;">• </span> Transportation benefits <br /><span style="margin-left:10px;">• </span> Employee Assistance Program <br /><span style="margin-left:10px;">• </span> Time Off/Leave (PTO, Vacation or Sick Leave)</p><strong>Workplace Type</strong><p>This is a fully remote position.</p><strong>Application Deadline</strong><p>This position is anticipated to close on Apr 30, 2026.</p>h4>About TEKsystems: <p>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. </p> <p>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.</p> <h4>About TEKsystems and TEKsystems Global Services </h4> <p>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.</p> <p>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.</p>