Claims Representative

🔥 8 minutes ago

⛰️ Colorado, Florida, +14 more states – Remote

⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌾 Nebraska – Remote 🏖️ New Jersey – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote 🍑 Georgia – Remote

💵 $19 / hour

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

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WPS Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🛡️ Insurance

🏥 Healthcare

🏛️ Government

💰 Venture Round on 2025-10

Insurance • Healthcare • Government

WPS Health Solutions is a not-for-profit health solutions company based in Madison, Wisconsin, with nearly 80 years of experience providing health insurance and benefits plan administration to private and government members. It operates four divisions—Government Services (administering Medicare, Medicaid, and military health benefits), Health Plan (offering individual, family, employer insurance and Medicare supplement plans), Data Logistics (secure document handling services like printing, mailing, scanning, digitizing, shredding), and New Ventures (investing in startups and entering new markets). The company also partners with nonprofits to support mental health and wellbeing for veterans, military members, women, and children.

📋 Description

• Process Medicare Part A and Part B claims from receipt through resolution • Review complex and specialty claims using federal and internal guidelines • Apply processing guidelines, payment rules, and manual calculation procedures • Handle complex adjustments involving multiple admissions and pending returned notices • Manually adjust reconsiderations, including patient complaints and denials • Communicate with internal departments, healthcare providers, and members to clarify claim issues • Interact with providers by phone to resolve pending claim problems • Correspond with providers, other contractors, and QIOs regarding claim-related problems • Assist the department in meeting CMS performance metrics and quality and quantity standards • Support the Claims department and provide backup for staff responsibilities • Keep current with regulatory, coding, and plan-policy changes • Maintain compliance with privacy, confidentiality, data security, and program-integrity requirements

🎯 Requirements

• High School Diploma or GED or equivalent experience • One (1) or more years of experience in hospital, clinic and/or medical office billing • One or more years of post-high school education or coursework in insurance or medical-related studies • Experience in a position using computer, keyboarding, and customer communications • Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy • Ability to multitask, prioritize, problem-solve, and effectively adapt to a fast-paced environment • Ability to work independently and meet quality and production standards • Wired (ethernet cable) internet connection from your router to your computer • High speed cable or fiber internet • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection • Previous health/Medicare adjudication experience preferred • Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims preferred • Familiarity with medical terminology, procedure and diagnosis codes preferred • Ability to comply with Federal Privacy Act, ISO 9000, Freedom of Information, Desk Disclosure Reference, and WPS conflict of interest and confidentiality requirements • Subject to screening and background investigation including fingerprinting • Must work Monday-Friday between 7:30am-4:00pm CT during training without missing time • Able to work 8-hour shifts between 6am-6pm CT once trained

🏖️ Benefits

• Remote work options available • Performance bonus and/or merit increase opportunities • 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately) • Competitive paid time off • Health insurance, dental insurance, and telehealth services start DAY 1 • Professional and Leadership Development Programs

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