<h3>Job Description</h3>
Job DescriptionAbout the Role
We are seeking a detail-oriented and dependable Reimbursement Processor to join our Reimbursement Services team. In this role, you will be responsible for adjudicating and entering Flexible Spending Account (FSA) reimbursement requests and Benefits Card receipt submissions. You’ll play a key part in ensuring timely and accurate processing while maintaining the highest standards of confidentiality and compliance.
What You’ll Do
<ul>
<li>Review and adjudicate FSA claims up to $5,000</li>
<li>Process Benefits Card receipt requests</li>
<li>Accurately enter claims into participant accounts</li>
<li>Update participant demographic information as needed</li>
<li>Process third-party FSA claim files</li>
<li>Maintain strict confidentiality and security of sensitive information</li>
</ul>
What You Bring
<ul>
<li>High School Diploma or equivalent</li>
<li>At least 1 year of experience in a professional office setting</li>
<li>Strong attention to detail and commitment to accuracy</li>
<li>Proficiency in Microsoft Excel and Outlook</li>
<li>Typing speed of at least 50 WPM and 10-key speed of 9,500 KPH</li>
</ul>
Preferred Qualifications:
<ul>
<li>Prior experience in claims processing</li>
<li>Familiarity with tax-advantaged benefit plans</li>
<li>Basic proficiency in Microsoft Word</li>
</ul>
Why Join Us
<ul>
<li>Be part of a collaborative team of 5+ professionals</li>
<li>Contribute to a high-impact area during our busy renewal season</li>
<li>Gain valuable experience in the benefits and reimbursement space</li>
<li>Support meaningful work that directly impacts our customers</li>
</ul>
Apply today to join a team that values precision, integrity, and service excellence.
Pay and Benefits
The pay range for this position is $17.00 - $18.00/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 &amp; vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life &amp; AD&amp;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)
Workplace Type
This is a hybrid position in Middleton,WI.
Application Deadline
This position is anticipated to close on Oct 15, 2025.
h4&gt;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.
About TEKsystems and TEKsystems Global Services
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.
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.

Healthcare Claims Reimbursement Processor

<h3>Job Description</h3>
Job Description
HEALTHCARE CLAIMS PROCESSOR JOB SUMMARY: CDS Administrators is looking for an experienced Healthcare Claims Processor to join our growing team! CDS specializes in benefit administration and prioritizes exceptional customer service. We are looking for people who want to further their career and find a place to call home. This position requires attention to detail, analytical thinking / problem solving and great organizational skills.
This is a full time, direct hire in office role. Working hours are 8:30am to 5:00pm in our Downtown office.
QUALIFICATIONS
<ul>
<li>High School Diploma Required</li>
<li>Must have at least 1-year previous experience processing claims – medical claims experience preferred</li>
<li>Must have the ability to manage their own time throughout the day while actively addressing client and team requests</li>
<li>Must have strong problem-solving skills</li>
<li>Proficiency in core MS Office applications including Word, Excel, PowerPoint, and Outlook.</li>
<li>Proficiency in role specific software / Ability to learn new software quickly</li>
<li>Previous experience with, data entry and data analytics preferred.</li>
<li>Must be willing to submit to a background investigation; any offer of employment is conditional upon the successful completion of a background investigation.</li>
</ul>
HEALTHCARE CLAIMS PROCESSOR PAY &amp; PERKS:
<ul>
<li>Hourly Rate Starting At $20.00 per hour</li>
<li>Monday to Friday schedule</li>
<li>Professional development and coaching</li>
<li>Health, Dental, and Vision insurance</li>
<li>401(k)</li>
<li>Life insurance</li>
<li>Paid time off</li>
</ul>
HEALTHCARE CLAIMS PROCESSOR DUTIES &amp; RESPONSIBILITIES:
As a Healthcare Claims Processor, you will be responsible for analyzing, reviewing, and adjudicating medical, dental, and vision claims while maintaining exceptional customer service, including providing information to providers as well as participants regarding eligibility, benefits, and claim status.
<ul>
<li>Answer/resolve incoming participant and provider calls</li>
<li>Conduct outbound calls to follow up on participant concerns</li>
<li>Process medical, dental and vision claims</li>
<li>Data entry for claims processing</li>
<li>Able to read, analyze, and understand Explanation of Benefits</li>
<li>Understand and effectively communicate covered/non-covered benefits, deductibles, maximum amounts, limitations, and exclusions</li>
<li>Able to read, analyze, and understand Plan Documents and Summary Plan Descriptions</li>
</ul>
ABOUT US: CDS Administrators, Inc. (CDS) is a locally owned and operated employee benefit services firm in the greater Pittsburgh area. We are seeking candidates interested in working in a fast-paced environment in a growing organization. We promote from within, and are invested in training and development.

Healthcare Claims Processor in Downtown, Pittsburgh

<h3>Job Description</h3>
Job DescriptionDescription:
Job Summary:
 
The Clinical Pharmacist will be the primary liaison for clinical and cost containment insights to the medical-only book of business for internal and external-facing clients. Responsible for overall retention and satisfaction within their book of business. Provide clients with appropriate utilization and financial reporting that includes summaries of key focus areas and recommendations. Serve as pharmacy SME in support of AMPS/Drexi client service staff.
 
Essential Job Duties:
 
• Maintain confidentiality and HIPAA guidelines to ensure the confidentiality of all members and clients.
• Provide overview and advice on local, state, and federal legislative, legal,l and industry requirements for PBM 
practices, including but not limited to PPACA, HIPAA, etc.
• Review, edit, maintain, or create and support standard and client-specific drug formularies and formulary 
management efforts for PBM and RBR/MBR customers and prospects.
• Review, edit, maintain, or create and support standard and client-specific Prior Authorization protocols.
• Review and determine clinical dispositions regarding pharmacy, patient, and prescriber-generated prior 
authorization requests per established response guidelines determined by the company and its client 
contracts requirements.
• Review, edit, maintain, or create and support standard and client-specific MAC (Maximum Allowable Cost) 
lists and protocols.
• Support client retention, renewals, upsells and client satisfaction.
• Provide review and evaluation of client and prospect drug utilization review, provide financial and clinical 
insights to support internal and external client needs.
• Provide review and advice on Pharmacy Provider Contracting when required.
• Review, edit, maintain, or create and support standard and client-specific Drug Utilization and financial 
impact reporting protocols.
• Review, edit, maintain, or create and support the additions of new specialty, brand, and generic product 
introductions.
• Review, edit, maintain, or create and support standard and client-specific Rebate contracts and performance 
guarantees associated with such contracts.
• Review, edit, maintain, or create and support the development of an organizational standard for MSP 
(manufacturer savings programs), PAP (patient assistance programs), CAP (copay assistance programs) 
assisting clients in attaining the maximum plan and member benefits of such programs.
Advanced Medical Pricing Solutions (AMPS) provides market-leading healthcare cost containment services for self-funded employers, public entities, brokers, 
TPAs, payers, and many other entities. As we continue to grow, we look for driven professionals who share our core values. We take a “one team” approach 
to keeping clients satisfied and engaged with our products and services for the long term. 
• Review, edit, maintain, and support the standard operating procedures for external advocacy companies that 
provide MSP (manufacturer savings programs), PAP (patient assistance programs), CAP (copay assistance 
programs), and assist clients in attaining maximum plan and member benefits of such programs.
• Support the standard operating procedures for clients that create and service pharmaceutical manufacturers 
regarding MSP (manufacturer savings programs), PAP (patient assistance programs), and CAP (copay assistance 
programs) where AMPS/Drexi is the back-end claims processor for such claims.
• Facilitate the appropriate claim migration and utilization of international drug sourcing for clients that have 
adopted this strategy.
• Support clinical and financial review of multiple accounts; develop a positive working relationship with all 
client touchpoints when and where necessary.
• Focus on ensuring we maintain superior customer service levels, operational excellence and strategic insight.
• Support new business implementations.
• Maintain account activity within the CRM system.
• Closely coordinate with Marketing, Product, and Sales areas on applicable initiatives as directed by 
leadership.
• Other training and project initiatives as directed and assigned by leadership.
Requirements:
Skills/Abilities:
 
• Excellent verbal and written communication skills
• Strong understanding of the PBM industry required.
• Strong data management experience and skills preferred.
• Healthcare, health plan, ERISA self-funded employer, and TPA experience preferred.
• Excellent customer service skills
• Strong analytical and problem-solving skills
• Confident decision-making abilities
• Detail-oriented, flexible, and strong organizational skills
• Ability to work independently and within a team environment.
• Ability to travel on an as-needed basis
 
Education/Experience:
 
• Bachelor’s Degree or PharmD (preferred) degree from an accredited US School of Pharmacy
• Current Pharmacy License in good standing with the state that has issued that license
• Minimum of 5 - 7+ years pharmacy experience within the PBM or Managed Care industry
 
Physical Requirements:
 
• Commensurate with position/as defined by HR

Clinical Pharmacist

<h3>Job Description</h3>
Job DescriptionSalary: $17.00 per hour DOE 
Mailroom Document Processor
 
 
Job Type: Full-time
Salary: $17.00 per hour
Work Schedule: Monday Friday 7:00 am 3:30pm
 
Work Location: Lake Forest, CA
Background Screen required
 
 
Position Summary:
Imagenet is a leading provider of healthcare technology services around the country. We pride ourselves on our diverse and dedicated workforce and know that having varied perspectives generates better ideas. We promote from within whenever possible so that everyone has the opportunity to grow with the company.
 
Due to the strong and growing demand for our services, our company is expanding its operations. We are now seeking a reliable Mailroom Prep Clerk to help support our team and contribute to our continued success.
 
 
What We Offer:
<ul>
<li>Genuine work/life balance - a predictable schedule and no night shifts</li>
<li>Paid training period</li>
<li>Medical, Dental, Life, Vision, HSA, 401K</li>
<li>PTO</li>
<li>7 Paid Holidays</li>
</ul>
 
What You'll Do:
<ul>
<li>Learn about different types of healthcare documents and how to operate mailroom equipment.</li>
<li>Open mail, identify document types, and group documents together.</li>
<li>Hand off documents to our scan team - may require standing, walking, bending, and lifting 30~ pounds (one Banker's Box).</li>
</ul>
 
What We're Looking For:
<ul>
<li>You show up to work on time every day.</li>
<li>You're always positive and professional.</li>
</ul>
<ul>
<li>You've worked in an office and have a high school diploma or equivalent.</li>
</ul>
 
The Ideal Candidate:
<ul>
<li>You can work independently or within a team.</li>
<li>You are good at time management.</li>
<li>You have a "can do" attitude.</li>
</ul>
 
 
Ready to join our growing team? Wed love to learn more about you! Click Apply Now to get started and tell us why youd be a great fit for Imagenet. 
 
 
About Imagenet, LLC 
Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans members and providers.
 
The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.
 
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

Mailroom Document Processor

<h3>Job Description</h3>
Job DescriptionDescription:
Open: 11/25/2025
Close: 12/11/2025
 
POSITION DESCRIPTION
 
POSITION: BILLING SPECIALIST II
 
RESPONSIBLE TO: Business Office Manager
 
SALARY: Step Range: 12 ($40,453) -31($70,934); Full Benefits 
 
CLASSIFICATION: Non-Management, Regular, Full-Time
 
LOCATION:
Klamath Tribal Health &amp; Family Services
3949 S. 6th Street, Klamath Falls, Oregon
 
BACKGROUND: Comprehensive 
 
POSITION OBJECTIVE
Klamath Tribal Health &amp; Family Services (KTHFS) is a tribally-operated health facility offering direct medical, dental, pharmacy, behavioral health, and non-emergent transportation services to Native Americans and Alaska Natives residing within the service delivery area. The Billing Specialist is responsible for managing patient accounts in a complex, multi-disciplinary Business Office environment. The incumbent shall cross-train with other members of the Klamath Tribal Health Business Office Staff and shall participate in all functions of the coding and billing cycle, to include: daily review of encounters, analyzing chart notes and assuring the appropriate service codes are utilized, data entry of encounter forms, posting charges into the computer system, perform claims review, claims submission, timely billing, follow-up and collection of all accounts, payment posting, claims audit and research. The incumbent shall also function as a resource for clinic providers and staff and will assist with coding and billing questions, and quality assurance activities.
 
MAJOR DUTIES AND RESPONSIBILITIES
1. Daily review, analyze, and interpret patient ambulatory EHR and/or paper encounter coding and corresponding chart note documentation and determine that the appropriate diagnostic and procedural codes are used and appropriately reflected in the chart note for code assignment as outlined by the CMS guidelines. Assuring that medical/dental necessity billing guidelines are met.
2. Ensure the appropriate service codes are applied in the billing record that corresponds to the documentation referenced in the chart note or on the encounter forms. Ensure that the appropriate ICD-10, CPT, HCPCS, CDT coding conventions have been used for services provided by all health service types within KTHFS, including but not limited to: medical, dental, behavioral health and transportation. 
3. Work with providers and nursing staff to clarify documentation in the EHR system if needed. Including correlating anatomical and physiological processes of a diagnosis to assure the most accurate ICD-10 code(s) are used. Advise supervisor and clinicians of deficiencies to support charge capture of all billable services.
4. Prepare and submit clean claims (electronic or paper) to primary/secondary insurance carriers including Medicaid, Medicare, (Part A&amp;B), and private insurance companies. 
5. Maintain compliance with billing regulations: including Medicaid (DMAP), Medicare (Parts A&amp;B, DME), Private Insurance Carriers (i.e. HMA, BCBS, ODS, etc.).
6. Payment post insurance checks or EFTs, which includes: verifying the checks or EFTs that have been receipted in the KTHFS Operations Support System, batching the checks or EFTs into the current billing system, and then accurately posting the payments into the current billing system.
7. Process refunds for any overpayments made to KTHFS. Monitor claims payment and promptly request POs for refunds to insurance companies, or perform electronic claim adjustments per payer requirements, for any overpayments made on claims. The refund will also be processed to reflect the claim refund in the practice management system.
8. Process No-Pay EOBs, applying an adjustment, create billing notes and claim follow-up. This includes the appeal of insurance claims that have been wrongfully paid or denied, contacting insurance companies by phone to obtain information concerning extent of benefits and/or settle unpaid claims and providing any additional information requested by insurance companies for the processing of submitted claims.
9. Record in NextGen system all claims related phone calls, correspondence, and activities related to each patient account.
10. Maintain current filing system for encounters, POs, &amp; etc.; process daily incoming mail and correspondence for review, completion, and filing.
11. Communicate regularly with Patient Registration Staff and record patient benefit effective/term date(s) into the practice management system as needed.
12. Create electronic batches to submit to clearinghouse in Nextgen and reconcile to claims spreadsheet including follow up on electronic claims receipt by payer. Correct any claims before archiving the file in the clearinghouse. 
13. Work outstanding A/R by reviewing, rebilling, and adjusting accounts to ensure accurate and thorough billing of claims, by running reports and working on claims. Track and monitor claims processing, ensure timely follow-up for the payment of bills; Identify, and resolve all outstanding/pending claims.
14. Monitor the Business Office outlook inbox regularly and back bill any claims and/or adjust claims where applicable.
15. Run specific reports as identified below:
· To be ran and worked weekly - Pending Charges Report, Unbilled Encounters, Paper Claims printed, Clearinghouse Reports (claims denied, outstanding claims, claims removed, claims rejected) 
· Biweekly reports - Kept Appointments with No Encounters report, Aging Reports, and maintain up to date reports making sure all old billing is addressed. 
16. Establish and maintain an effective working relationship with public and private payers; identify potential problems that could cause interruptions to cash flows.
17. Participate in yearly chart audit activities for quality assurance purposes; document results in report format, as needed, to be able to have reviewed by Clinical Director and Compliance Officer. 
18. Attend coding seminars, meetings, or other training opportunities to keep abreast of changes in the profession.
19. Like all employees of the Klamath Tribes, the incumbent will be called upon to accomplish other tasks that may not be directly related to this position, but are integral to the Klamath Tribes’ broader functions, including but not limited to, assisting during Tribal sponsored cultural, traditional, or community events that enable the successful operation of programs and practices of The Klamath Tribes as aligned with The Klamath Tribes’ Mission Statement. Some of these tasks may be scheduled outside of regular work hours, if necessary.
 
SUPERVISORY CONTROLS
Work under the supervision of the Business Office Manager, who provides general instructions. Work is assigned in terms of functional/organizational objectives. The manager assists with unusual situations that do not have clear precedents.
Employee must be able to work with minimal supervision, using initiative and judgement in setting priorities to meet the demands of the workload. Work is performed within the purview of laws, and regulations. The manager will review work regularly for quality and compliance with established policies and procedures and payer guidelines.
 
KNOWLEDGE, SKILLS, ABILITIES
Technical knowledge, skill, and understanding of the American Medical Association developed CPT coding system in order to acquire, interpret, and resolve problems based on information derived from system monitoring reports to be carried over to the required billing forms.
Technical knowledge, skill, and understanding of the concepts of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for classification of diseases and/or procedures.
Knowledge and understanding of CDT dental coding system.
Basic knowledge and understanding of HCPCS coding. 
Knowledge of mental health and alcohol and drug coding and billing is desirable.
Ability to work with minimal supervision, using initiative and judgment in setting priorities to meet the demands of the workload while adhering to the insurance rules and regulations that relate to coding and billing. 
The knowledge of and/or the ability to learn the billing guidelines as they pertain to FQHC/Tribal Health Clinics.
Knowledge of established procedures, required claim forms (both paper and electronic) associated with the various health insurance programs. 
In-depth knowledge of Medicaid (OARs, Rulebooks). 
In-depth knowledge of Medicare Part A &amp; B billing regulations.
Knowledge of medical terminology.
Knowledge of claims review, account auditing, and quality assurance.
The ability of tracking, handling, and completing multiple projects.
Ability to communicate well (both orally and in writing) and work effectively with other employees, managers, and administrators. This person should be able to express themselves in a clear and concise manner for the purposes of correspondence, reports and instructions, as well as for obtaining and conveying information to ensure a cooperative working relationship with all staff.
Willingness to maintain expertise to keep current with changes in procedure and diagnosis coding and third-party payer reimbursement policies through continuing education.
Above average ability to work with numbers and set standards in order to assure proper payment and adjustments posting.
Must be dependable, thorough, accurate, well-organized and detail oriented.
Ability to maintain strict confidentiality of medical records and adhere to the standards for health record-keeping, HIPAA and Privacy Act requirements.
Conduct self in accordance with KTH&amp;FS Employee Policy &amp; Procedure Manual.
 
QUALIFICATIONS, EXPERIENCE, EDUCATION
Minimum Qualifications: Failure to comply with minimum position requirements may result in termination of employment. 
· REQUIRED to possess a High School Diploma or Equivalent. (Must submit copy of diploma or transcripts with application.)
· REQUIRED Must have one of the following certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Medical Coder (RMC), RHIA, RHIT or an Associate’s degree in Medical Office Systems or Health Information Management.
· REQUIRED One (1) year of medical and/or dental billing and coding experience. Experience must be reflected on application; or submit copy of coder certification with application
· REQUIRED Demonstrated proficiency in the technical knowledge of medical terminology, anatomy and physiology, and CPT and ICD-10-CM coding systems
· REQUIRED to have Computer and/or word processor experience. 
· REQUIRED to submit to a background and character investigation, as per Tribal policy. Following hire must immediately report to Human Resource any citation, arrest, conviction for a misdemeanor or felony crime. 
· REQUIRED to submit to annual TB skin testing and adhere to KTHFS staff immunization policy in accordance with the Centers for Disease Control immunization recommendations for healthcare workers. 
· REQUIRED to accept the responsibility of a mandatory reporter in accordance with the Klamath Tribes Juvenile Ordinance Title 2, Chapter 15.64 and General Resolution #2005 003, all Tribal staff are considered mandatory reporters. 
Preferred Qualifications:
· AAPC coder certified or AHIMA coder certified.
· Experience with NextGen or other electronic health record system is preferred. 
Indian Preference:
· Indian Preference will apply as per policy. Must submit documentation with application to qualify for Indian Preference.
 
ACKNOWLEDGEMENT
This job description is intended to provide an overview of the requirements of the position. It is not necessarily inclusive, and the job may require other essential and/or non-essential functions, tasks, duties, or responsibilities not listed herein. Management reserves the sole right to add, modify, or exclude any essential or non-essential requirement at any time with or without notice. Nothing in this job description, or by the completion of any requirement of the job by the employee, is intended to create a contract of employment of any type.
 
APPLICATION PROCEDURE
Submit a Klamath Tribal Health &amp; Family Services Application for Employment with all requirements and supporting documentation to:
Klamath Tribal Health &amp; Family Services
ATTN: Human Resource
3949 South 6th Street
Klamath Falls, OR 97603
<a href="mailto:hr@klamathttribalhealth.org" target="_blank">hr@klamathttribalhealth.org</a>
 
IT IS THE RESPONSIBILITY OF THE APPLICANT TO PROVIDE SUFFICIENT INFORMATION TO PROVE QUALIFICATIONS FOR TRIBAL POSITIONS.
Please Note: If requirements are not met, i.e., submission of a resume in lieu of a tribal application or not including a required certification, your application will not be reviewed and will be disqualified.
Indian Preference will apply. In accordance with Klamath Tribal policy, priority in selection will be given to qualified applicants who present proof of eligibility for “Indian Preference”.
Applications will not be returned.
Requirements:

Billing Specialist II

<h3>Job Description</h3>
Job Description
We exist for workers and their employers -- who are the backbone of our economy.&nbsp; That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
Centivo is looking for Claims Processors to join our team!&nbsp; 
We provide a paid training program scheduled to start Monday, December 8, 2025.
As a Claims Processor you will manage and process healthcare claims for our self-funded employer groups. Health care providers treat patients, then file medical claims to receive payment from the patient’s Benefit Plan. Claim Processors review and assess the claims, adjudicating payment to the provider on behalf of the Plan if a claim is covered by the patient’s Benefit Plan. Claims Processors are responsible for working closely with the Claims Supervisor, Account Managers, System Configuration and Quality Assurance Team in ensuring that claims received by Centivo are adjudicated in a timely manner and accurately. Claims Team roles are based on skill level and increased responsibilities.
What you’ll do:
<ul>
<li>
Adjudicating claims in assigned work queues based on Centivo’s written Policies and Procedures and the terms of the Summary Plan Documents (SPD’s) for Centivo’s clients.
</li>
<li>
Diligently reviewing all system-generated edits which have been applied to claims in the Claims Processor’s assigned queues prior to releasing the claims to ensure benefits are being applied per the client’s SPD and client funds are being appropriately managed.
</li>
<li>
When the Claims Processor believes there may be an issue or inconsistency in the interpretation of a Plan as the system is applying benefits, immediately route the claim to the Plan Build/System Configuration Team for resolution.
</li>
<li>
When the Claims Processor is unable to resolve an edit based on the provider selection, the pricing and/or usual and customary discrepancies, immediately route the claim to the Provider Maintenance and/or Pricing teams for resolution.
</li>
<li>
When the Claims Processor is unable to resolve an edit based on the information included with or attached to a claim, appropriately deny the claim for additional information, and generate correspondence to the participant or provider concisely explaining data needs. When such additional data is received, reopen the denied claim, and re-adjudicate based on the information.
</li>
<li>
Maintain daily, weekly, and monthly required production levels documented in Claims Department Policies and Procedures.
</li>
<li>
Participation in Departmental quality improvement efforts and bring forward process improvement suggestions that will improve efficiencies; question a process or policy that creates additional steps or work on the Claims Processor and suggest an alternative solution.
</li>
<li>
Processes claims in accordance with established policies and procedures, contacting providers as needed, completing tasks under moderate supervision. Responsible for meeting the production and quality goals determined by the department leadership.
</li>
<li>
Increased responsibilities, which may include assisting and mentoring less experienced team members, participating in various initiatives or projects within the Claims Delivery Team, documenting processes, performing advanced tasks, supporting high dollar reviews, and overpayments/refunds.
</li>
</ul>
You should have:
<ul>
<li>
Prior experience with a highly automated and integrated claims processing system.&nbsp;
</li>
<li>
Experience working with HealthRules Payer preferred
</li>
<li>
Knowledgeable about healthcare claims, medical coding, and rules applicable to Benefit Plans.
</li>
<li>
Strong critical thinking skills and willingness to make independent decisions with little supervision.
</li>
<li>
Excellent oral and written communication skills.
</li>
<li>
Proven ability to work in a fast-paced environment, managing multiple issues with pressure of production schedules and deadlines.
</li>
<li>
Proven ability to work independently for majority of day.
</li>
<li>
Proficiency in Microsoft Office applications and other web-based software applications.
</li>
<li>
Ability to learn new proprietary computer systems.
</li>
<li>
High School diploma or GED required 
</li>
</ul>
Location: &nbsp;
<ul>
<li>
Remote
</li>
<li>
Must be available during standard working hours and willing to work overtime as business need requires.
</li>
</ul>
Note: A knowledge assessment may be required during the interview process
Centivo Values:&nbsp;
<ul>
<li>
Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.&nbsp;&nbsp;
</li>
<li>
Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.&nbsp;
</li>
<li>
Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive.&nbsp;&nbsp;
</li>
</ul>
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase &amp; Co.

Claims Processor

<h3>Job Description</h3>
Job Description
Location: Tempe, AZ (100% In-Office)
Employment Type: Full-Time
Compensation: $19.25/hr with potential increase to $20.00/hr upon permanent hire
Shift Differential: 1.25x for evenings, weekends, and overnight hours (e.g., $24.06/hr for eligible shifts)
 Job Overview
Join One Medical’s centralized support team and help transform the patient experience. As an Inbound Healthcare Contact Center Representative, you’ll be the first point of contact for patients and care partners navigating a complex healthcare system. You’ll provide compassionate, efficient service while managing inquiries related to insurance, billing, appointments, and care coordination.
Key Responsibilities
<ul>
<li>Handle high-volume inbound calls and messages from patients and care partners</li>
<li>Assist with insurance questions, billing inquiries, appointment scheduling, and medical record access</li>
<li>Coordinate care with pharmacies, labs, specialists, and insurance providers</li>
<li>Collaborate with providers and operations teams to complete urgent tasks</li>
<li>Apply C-I-CARE communication principles to ensure positive patient interactions</li>
<li>Use tools like Slack, Google Suite, Zoom, and EMR system (1Life) to complete daily tasks</li>
<li>Participate in team huddles, rounding, and problem-solving sessions</li>
<li>Support in-office providers with ad hoc requests</li>
</ul>
Required Qualifications
<ul>
<li>Minimum 1 year of high-volume contact center experience and 1 year of direct customer service experience (e.g., hospitality, banking, food service)</li>
<li>OR</li>
<li>2 years of patient-facing healthcare service experience (e.g., Patient Access Rep, Claims Processor, Pharmacy Tech)</li>
<li>Experience must be within the last 4 years with an average tenure of 1 year</li>
<li>Strong written and verbal communication skills with impeccable phone etiquette</li>
<li>Ability to multitask and navigate multiple software systems simultaneously</li>
</ul>
Employee Benefits &amp; Perks
<ul>
<li>Pay increase to $20/hr upon permanent hire</li>
<li>Brand new office location in Tempe</li>
<li>Paid sabbatical after 5 and 10 years</li>
<li>Employee Assistance Program for stress, financial, and legal support</li>
<li>Competitive Medical, Dental, and Vision plans</li>
<li>Free One Medical memberships for you and your family</li>
<li>Pre-tax commuter benefits</li>
<li>PTO cash-out option (up to 40 hours/year)</li>
<li>100% employer-paid life and disability insurance</li>
<li>401(k) match</li>
</ul>
Work Environment &amp; Schedule
<ul>
<li>100% in-office role with high-volume inbound calls and tasking between calls</li>
<li>Metrics include QA scores, availability, after-call work, and task completion</li>
<li>Focus on customer service and HIPAA compliance—not call handle time</li>
<li>Training: 4 weeks, Monday–Friday, 8:00 AM–5:00 PM with zero tolerance for absences</li>
<li>Must pass final training assessment with 80% or higher</li>
<li>Shifts available: Mon–Fri, Tues–Sat, or Sun–Thurs</li>
<li>Must be available for at least one weekend day</li>
<li>Shift bid process determines final schedule before start date</li>
</ul>
Job Type &amp; Location
This is a Contract position based out of Tempe, AZ.
Pay and Benefits
The pay range for this position is $19.25 - $19.25/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 &amp; vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life &amp; AD&amp;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)
Workplace Type
This is a fully onsite position in Tempe,AZ.
Application Deadline
This position is anticipated to close on Nov 21, 2025.
h4&gt;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.
About TEKsystems and TEKsystems Global Services
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.
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.

Centralized Support Specialist I

<h3>Job Description</h3>
Job Description&nbsp;
Benefit Design and System Support Analyst
We wanted a PBM that worked better… so we created one. &nbsp;
Liviniti, the leading disruptor in the PBM industry, simplifies the complexities of navigating through the Pharmacy Benefit Manager world by offering a value-added approach to ensure the employer absolute freedom, control, and choice to their health plan structure without compromising patient experiences and outcomes. &nbsp;We improve healthcare and reduce rising prescription costs for employers and their employees. We are looking for individuals who are passionate, strong, and committed to developing systems and service solutions that promote our business goals and commitments.
Liviniti&nbsp;is searching for incredible talent! &nbsp;We continue to experience&nbsp;accelerated growth in a rapidly changing industry. There's never been a better time to join our team. &nbsp;
We are currently seeking a Benefit Design and System Support Analyst. This is a remote position.
Role and Responsibilities
The Benefit Design and System Support Analyst provides Liviniti employees and customers with comprehensive knowledge of the claim processing system. This includes answering questions and assisting with problem resolution.
<ul>
<li>Manages tickets within a ticketing system; troubleshoots and resolves tickets that are placed in the claims processing queues in a timely manner. &nbsp;</li>
<li>Adjudicates information on multiple software platforms. &nbsp;</li>
<li>Enforces procedures that are put in place by the Benefit Design Supervisor, Director of Claims Processing, and other Leadership.&nbsp;</li>
<li>Identifies and corrects Benefit Design errors within the claims processor based on client documentation. This may include performing financial audits on the error(s) found and determining impact for the client and/or Southern Scripts. &nbsp;</li>
<li>Provides and potentially presents audit findings to Account Management and, on occasion, the Leadership team. &nbsp;</li>
<li>Facilitates benefit designs for new clients within the claims processor based off of documentation.</li>
<li>Communicates with the Implementation team to discuss and/or ask questions regarding benefit designs for new clients.</li>
<li>Communicates with the EDI team to discuss and/or ask questions regarding various data files.</li>
<li>Communicates with the Clinical team to discuss and/or ask questions regarding clinical edits that are active for current clients.</li>
<li>Works in conjunction with the Clinical team to input information into the claims processor and makes updates based on extensive testing to ensure the clinical request is to appropriate specifications.</li>
<li>Communicates with the Account Management team to facilitate benefit design updates and obtain appropriate documentation for current clients.</li>
<li>Assists Customer Service Representatives with troubleshooting and resolving issues within our claims processor, when appropriate.</li>
<li>Works in conjunction with an external programming team to analyze and resolve programming error(s) within our claims processor.</li>
<li>Participates in developing additional quality assurance for internal processes.</li>
<li>Plays an active role in evaluating quality standards from an objective point of view and ensuring the proper checks and balances are applied to all parts of the Claims Processing procedures.</li>
<li>Abides by all obligations under HIPAA related to Protected Health Information (PHI).</li>
<li>If a HIPAA violation is discovered, whether individually or by another, reports the violation to the Compliance Officer and/or Human Resources.</li>
<li>Attends, completes, and demonstrates competency in all required HIPAA Training offered by the company.</li>
<li>Flexibility to understand, appreciate and embrace that the job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. &nbsp;Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.</li>
</ul>
What We Have to Offer
Our benefits package is designed to keep our employees happy and healthy – physically, mentally and financially.&nbsp;
<ul>
<li>Medical, Dental, Vision insurance</li>
<li>Disability and Life insurance</li>
<li>Employee Assistance Program</li>
<li>Generous Paid-Time Off</li>
<li>Annual Reviews and Development Plans</li>
<li>Retirement Plan with company match immediately 100% vested</li>
</ul>
Required Skills and Competencies
<ul>
<li>Organization</li>
<li>Time Management</li>
<li>Strong Problem-Solving Skills</li>
<li>Strong communication/collaboration skills</li>
<li>Easily adapt to and learn new technology and skills</li>
<li>Thoroughness</li>
</ul>
Supervisory Responsibility
This position has no supervisory responsibilities.
Position Type and Expected Hours of Work
This is a full-time salaried position. &nbsp;Days and hours of work are Monday through Friday; 40+ hours a week, with occasional after-hours or weekend duties. &nbsp;Position can be remote or onsite.&nbsp;
Travel
No travel expected for this position.
Qualifications and Education Requirements
<ul>
<li>Associate or Bachelor’s degree preferred.</li>
<li>2 to 3 years’ previous experience working in PBM environment, health plan, pharmacy chain, or managed care services organization in a Systems or Plan Design capacity.</li>
<li>Intermediate or advanced proficiency with MS Excel, Word, PowerPoint, Outlook</li>
<li>Excellent verbal and written communication skills, establishing rapport and working with others.</li>
</ul>
 
Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Liviniti complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Liviniti expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti employees to perform their job duties may result in discipline up to and including discharge. &nbsp;EOE M/F/V/D
 
 
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