Onsite only - must be a local candidate. Monday-Friday, 7:30am-4pm. Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.
40% Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
40% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards.
20% Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.
This is a fast paced, high-volume team that works primarily independently with minor collaborations. Given that this is a research driven position, we require high attention to detail and ability to follow written instructions. Additional skills and qualifications required:
Education: High School Diploma or equivalent
Required Work Experience: 1 year of experience in a claims/appeals processing, customer service, or other related support area OR Bachelor's Degree in lieu of work experience.
Preferred/Nice to Have Skill Sets/Qualities: Organized, fast-paced, efficient
Adaptability Some processes have the potential to change on a whim. If this happens, need to be ready to change with it
Fast learner Need someone who can get up to speed quick
Communication need to be able to clearly and effectively communicate issues to management
Motivated Someone who is eager to learn and perform their best every day
Self-driven Someone who can work independently
Experience Level: Entry Level
Job Type & Location: This is a contract position based out of Columbia, SC.
Pay and Benefits: The pay range for this position is $17.50/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:
Workplace Type: This is a fully onsite position in Columbia, SC.
Application Deadline: This position is anticipated to close on Dec 24, 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.
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