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Claims Processing Jobs in Appleton, WI (NOW HIRING)

Network Health

Claims Analyst II

Menasha, WI · On-site +1

Process payments for claims that are approved. This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health. Location:

New

Network Health WI

Claims Analyst II

Menasha, WI · On-site

Process payments for claims that are approved. This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health. Location:

H.J. Martin and Son

Claims Manager

Green Bay, WI · On-site

Explaining the claims process to homeowners and contractors * Properly handling customer's complaints and concerns * Ensure a positive outcome for all customers * Labeling electronic folders and ...

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 ...

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All JobsClaims Processing JobsClaims Processing Jobs in Appleton, WI

Claims Processing information

See Appleton, WI salary details

$11

$18

$25

How much do claims processing jobs pay per hour?

As of Jun 21, 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 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 job makes $10,000 a month without a degree?

Claims processing roles can sometimes pay $10,000 or more per month for experienced professionals, especially in senior or specialized positions within insurance companies or third-party claims organizations. These roles often require strong analytical skills, industry knowledge, and certifications but may not require a college degree. High earnings typically depend on experience, performance, and the complexity of claims handled.

What is a claims processing job?

A claims processing job involves reviewing, verifying, and managing insurance claims to determine coverage and payment amounts. It requires attention to detail, knowledge of insurance policies, and often the use of specialized software to ensure accurate and timely claim handling.

What jobs pay 500,000 a year in the US?

Claims processing roles typically do not pay $500,000 annually; high-paying jobs in the US reaching this level are usually executive positions such as CEOs, investment bankers, or specialized medical professionals. Achieving such income often requires extensive experience, advanced skills, and leadership responsibilities across industries like finance, healthcare, or technology.

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 jobs pay 2000 a day?

Claims processing roles typically do not pay $2,000 a day; high earnings in this field are usually associated with senior positions, specialized consultants, or those with extensive experience and certifications. Most claims processors earn a standard salary or hourly wage, with top executives or highly specialized professionals potentially earning higher daily rates through consulting or bonuses.

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 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 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

Claims Analyst II

Network Health

Menasha, WI • On-site, Remote

Full-time

Posted 2 days ago

Job description

Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team.

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following:

  • Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.
  • Resolve claims and related issues in compliance with policy provisions.
  • Compare claims applications and provider statements with policy files and other records to ensure completeness and validity.
  • Process payments for claims that are approved.

This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health.
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.
Hours: 1.0 FTE, 40 hours per week between 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:

    • Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality.
    • Reviews claims to ensure compliance with proper billing standards and completeness of information. 
    • Obtains additional information from appropriate person and/or agency as needed.  
    • Maintains department quality standards.
    • Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality standards.
    • Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly.
    • Investigates and resolves pending claims in accordance with established time frames.  Identifies claims needing to be pended or suspended. Reviews pending claims timely and denies claims after established time frame is reached without resolution.
    • Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed.
    • Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc.
    • Reviews home office claims for payment up to $18,000.00.
    • Reviews claims for re-pricing.  Enters eligible claim data into appropriate WRAP network re-pricing website.  Overrides claims allowed amounts to apply internal/external discounts.
    • Appropriately documents attributes and memos for pertinent information related to claims payment.
    • Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract.
    • Performs other duties and responsibilities as assigned. 

    Job Requirements:

    • High school diploma or equivalent preferred. 
    • 2-4 years claims processing experience required
    • Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation.
    • Past experience using QNXT™ Claims Workflow a plus
    • Prior experience with ACA, Medicaid, or similar health plans preferred.
    • Coding experience preferred.

     

    Network Health is an Equal Opportunity Employer.

    Apply