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Claims Processing Jobs in Appleton, WI (NOW HIRING)

U.S. Venture, Inc.

Sr. Claims Coordinator

Appleton, WI · On-site

This role utilizes advanced claims knowledge to review claim activity, support litigation matters, and provide guidance on claims processes while working under the direction of the Claims Lead. The ...

Us Venture

Sr. Claims Coordinator

Appleton, WI · On-site

This role utilizes advanced claims knowledge to review claim activity, support litigation matters, and provide guidance on claims processes while working under the direction of the Claims Lead. The ...

Network Health, Inc

SQL/ETL Developer I

Menasha, WI · On-site +1

$52.25 - $68.25/hr

The ETL Developer I is part of a team dedicated to supporting Network Health's core claims processing system, related data integrations, vendor extracts and reporting. This individual will perform ...

Network Health

SQL/ETL Developer I

Menasha, WI · On-site +1

$52.25 - $68.25/hr

The ETL Developer I is part of a team dedicated to supporting Network Health's core claims processing system, related data integrations, vendor extracts and reporting. This individual will perform ...

Network Health WI

SQL/ETL Developer I

Menasha, WI · On-site

$52.25 - $68.25/hr

The ETL Developer I is part of a team dedicated to supporting Network Health's core claims processing system, related data integrations, vendor extracts and reporting. This individual will perform ...

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How much do claims processing jobs pay per hour?

As of May 30, 2026, the average hourly pay for claims processing in Appleton, WI is $18.69, according to ZipRecruiter salary data. Most workers in this role earn between $15.96 and $20.14 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Processor, and why are they important?

To thrive as a Claims Processor, you need a solid understanding of insurance policies and claims procedures, typically supported by a high school diploma or equivalent and relevant on-the-job training. Familiarity with claims management software, data entry systems, and basic office applications is essential. Strong attention to detail, analytical thinking, and effective communication skills help you resolve claims accurately and efficiently. These skills ensure the timely and proper handling of claims, enhancing customer satisfaction and minimizing errors or fraudulent activity.

What are some common challenges faced by professionals in claims processing, and how can they be managed effectively?

Professionals in claims processing often deal with high volumes of work, tight deadlines, and complex cases that require attention to detail. Managing these challenges involves staying organized, utilizing claims management software efficiently, and continuously updating knowledge of insurance policies and regulations. Effective communication with team members and other departments is also crucial to resolve discrepancies quickly and ensure accurate claim adjudication. Many organizations offer ongoing training and mentorship to help staff adapt to changes and improve efficiency.

What is claims processing?

Claims processing is the procedure by which insurance companies or organizations review and manage claims submitted by policyholders or clients. This involves verifying the details of the claim, ensuring all necessary documentation is provided, assessing the validity of the claim, and determining the appropriate payout or resolution. Claims processors play a crucial role in ensuring claims are handled efficiently, accurately, and in compliance with company policies and regulations.

What is a claims processing job?

A claims processing job involves reviewing, verifying, and managing insurance claims to determine their validity and appropriate payout. It requires attention to detail, knowledge of insurance policies, and often involves using specialized software to track claim status and ensure timely resolution.

What is the difference between Claims Processing vs Claims Adjuster?

AspectClaims ProcessingClaims Adjuster
CredentialsHigh school diploma or equivalent; certifications varyHigh school diploma; often state licensing or certifications
Work EnvironmentOffice-based, administrative settingFieldwork and office-based, investigative environment
Industry UsageInsurance companies, healthcare providersInsurance companies, claims departments
Job FocusReviewing and processing claims for paymentInvestigating claims, determining liability and settlement

Claims Processing involves reviewing and managing insurance claims to ensure proper payment, focusing on administrative tasks. Claims Adjusters investigate claims, assess damages, and determine liability. While both roles work within the insurance industry, Claims Processing is more administrative, whereas Claims Adjusters are investigative and evaluative.

What are popular job titles related to Claims Processing jobs in Appleton, WI? For Claims Processing jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Claims Processing jobs in Appleton, WI look for? The top searched job categories for Claims Processing jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Claims Processing jobs? Cities near Appleton, WI with the most Claims Processing job openings:
Claims Processing jobs near you
Infographic showing various Claims Processing job openings in Appleton, WI as of May 2026, with employment types broken down into 1% As Needed, 78% Full Time, 19% Part Time, 1% Contract, and 1% Nights. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $38,878 per year, or $18.7 per hour.

Family Savings Plan Claims Analyst

Network Health, Inc

Menasha, WI • On-site, Remote

Full-time

Posted 11 days ago

Job description

The Family Savings Plan (FSP) Claims Analyst is responsible for the accurate and timely entry, processing, adjudication, and auditing of medical and pharmacy claims. This role supports end-to-end claims operations and ensures compliance with established policies, procedures, contractual requirements, and regulatory guidelines while contributing to operational excellence and service quality.
Key responsibilities include high-volume data entry of medical and pharmacy claims, detailed claims review and adjudication, quality audits, and participation in training and continuous improvement initiatives. The analyst plays a critical role in maintaining data integrity, identifying discrepancies, and ensuring accuracy and consistency across claims systems and processes.
This position requires strong collaboration with cross-functional stakeholders across multiple levels of the organization to support strategic objectives, operational efficiencies, and service excellence. The FSP Claims Analyst may also assist with benefit interpretation, in-depth review and analysis of medical and pharmacy claims, and comprehensive claims research to resolve complex issues, discrepancies, or inquiries.
Additionally, the individual is expected to effectively communicate findings and recommendations, demonstrate strong analytical and problem-solving abilities, and handle confidential and sensitive information with professionalism and discretion. A commitment to accuracy, productivity, accountability, and customer-focused service is essential in supporting organizational priorities and delivering high-quality claims management outcomes.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model. Travel to the office in Menasha or Brookfield will be required occasionally for the position, including on first day.
Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday
Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:

    • Perform accurate and timely data entry of member- and provider-submitted medical and pharmacy claims.
    • Process medical and pharmacy claims in accordance with established policies, procedures, contractual requirements, and regulatory guidelines.
    • Audit claims to ensure accuracy in data entry, coding, and payment, identifying and correcting discrepancies as needed.
    • Demonstrate behaviors consistent with Network Health’s mission, vision, values, and organizational philosophy.
    • Respond to internal inquiries regarding claim status, issues, and benefit interpretation within established turnaround times (typically within 24 hours) to meet departmental metrics and contractual standards.
    • Proactively follow up with internal departments to resolve outstanding issues or concerns, and appropriately escalate complex or unresolved matters to a Supervisor or designated contact.
    • Maintain strong attention to detail, accuracy, and productivity standards while handling sensitive and confidential information.
    • Perform additional duties and responsibilities as assigned to support departmental and organizational goals.

    Job Requirements:

      • HS Diploma required, associate degree preferred
      • 2+ Years working in the health insurance industry preferred
      • Data entry, medical and pharmacy claims processing experience strongly preferred
      • Medical terminology experience preferred


      Network Health is an Equal Opportunity Employer

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