Medical Claims Customer Service Representative (remote) - Remote Eligible

Job Opportunity: Call Center Representative

Provide call center callers with timely, accurate, and customer-focused claim information, solicit information needed to perfect the claim, consistently deliver a superior level of customer service, document the claim system, work with the Supplemental Health and Limited Medical Benefit products, and perform well in a call center team environment. Required skills and abilities include: minimum of 2 years of experience in a call center environment, within the health insurance/medical claims industry; strong understanding of health insurance claims and benefits; knowledge of HFCA 1500 & UB04 forms; ability to recognize CPT & revenue cycle codes; high school diploma or GED; proficiency in MS Office applications.

Key responsibilities include: providing customers with timely, accurate, and customer-focused benefit and claim information; soliciting and entering the information needed to enter and process claims accurately and in a timely manner; recording summaries of information exchanged in our claim system with a high level of accuracy and detail easily understood by the user; issuing timely and accurate claim acknowledgement correspondence; processing incoming documents with high coding integrity and distributing immediately; remaining fully compliant with operational standards; meeting or exceeding call center operational metrics; entering incoming claims information with high degree of accuracy, meeting or exceeding established metrics; comprehensively reviewing and evaluating appeal and complaint requests to identify and classify member and provider appeals; determining eligibility, benefits, and prior activity related to the claims, payment, or service in question; researching appeal files for completeness and accuracy and investigating deficiencies.

Details: 100% remote | equipment provided. Applicants must provide the internet and a quiet workspace. Schedule: Monday to Friday | 8:30am – 5:00pm (PST). (45-minute lunch break, 38.5 hours per week) Pay: $20 - $22/hr. Pay cycle – Weekly | Medical, dental & vision benefits offered.

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Jan 22, 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.