Role Description We are seeking an experienced Claims Examiner to join our team. In this role, you will be responsible for researching, reviewing, correcting, and resolving pended medical claims while ensuring compliance with company policies, procedures, and regulatory guidelines. The ideal candidate will have prior claims examination experience and a strong understanding of medical claims processing, claims adjudication, and denial management. - Research, review, and resolve pended medical claims in a timely and accurate manner. - Determine claim payment eligibility based on established policies, procedures, and benefit guidelines. - Analyze and adjudicate medical claims while ensuring accuracy and compliance. - Review audit reports and take appropriate corrective actions as needed. - Investigate and respond to claim discrepancies, denials, and processing issues. - Maintain correspondence related to required documentation, medical records, CPT codes, HCFA forms, and other claim-related information. - Ensure adherence to regulatory requirements and organizational compliance standards. - Collaborate with internal departments to resolve claim issues and improve processing efficiency. - Document findings and maintain accurate records of claim reviews and determinations. Qualifications - High School Diploma or equivalent. - Previous experience as a Claims Examiner. - Experience with medical claims processing and claims adjudication. - Knowledge of medical billing and coding concepts. - Ability to review and interpret claim documentation and medical records. - Strong analytical, problem-solving, and decision-making skills. - Excellent attention to detail and organizational skills. Requirements - Experience handling medical claim denials and appeals. - Working knowledge of CPT, HCFA, and medical coding standards. - Experience reviewing audit reports and ensuring regulatory compliance. - Prior experience within a healthcare payer, insurance, or managed care environment. Benefits - 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) Company Description 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.

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. • Negotiating settlement of claims within designated authority. • Communicating claim activity and processing with the claimant and the client. • Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

• To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. • Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. • Negotiating settlement of claims within designated authority. • Communicating claim activity and processing with the claimant and the client. • Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

• Analyze workers compensation claims on behalf of our valued clients to determine benefits due. • Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. • Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. • Negotiating settlement of claims within designated authority. • Communicating claim activity and processing with the claimant and the client. • Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.