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Insurance Claims Processing Jobs in Wisconsin (NOW HIRING)

Sanford Health

Manager, Claims

Marshfield, WI · Remote

... health insurance claims submitted by providers and patients for processing. Responsible for the implementation and day-to-day performance of process activities related to claims research and ...

TEKsystems

Claims Processor

Brookfield, WI · On-site +1

$19.25/hr

The ideal candidate will have prior claims processing experience, strong attention to detail, and ... Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term ...

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battleface

Claims Adjuster

Stevens Point, WI · On-site

For too long, travel insurance has centered on the company and not the traveler. We're changing ... Process invoices through cost-containment networks * Maintain clear, timely updates to customers ...

Radiant Info Systems Ltd

Claims Manager

Milwaukee, WI · On-site

... insurance, managed care programs, claims processing (preferably Medicaid and Medicare claims), and knowledge of billing codes (CPT, ICD-9, HCPCS, RUGS, CMS and DRG pricing). A combination of ...

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Insurance Claims Processing information

What is insurance claims processing?

Insurance claims processing is the procedure by which insurance companies review, investigate, and settle claims made by policyholders. This process involves verifying the details of a claim, ensuring it meets the terms of the policy, and determining the appropriate payout or action. Claims processors handle documentation, communicate with claimants, and may work with other parties like adjusters or healthcare providers. The goal is to ensure claims are resolved efficiently, accurately, and fairly according to policy guidelines.

What are the key skills and qualifications needed to thrive in insurance claims processing?

To excel in Insurance Claims Processing, you need strong attention to detail, analytical abilities, and a foundational understanding of insurance policies or claims procedures, often supported by a high school diploma or associate degree. Familiarity with claims management software, databases, and sometimes industry certifications like AIC (Associate in Claims) is common. Effective communication, problem-solving skills, and the ability to manage stressful situations make someone stand out in this role. These competencies are critical for ensuring claims are processed accurately, efficiently, and in compliance with regulatory standards.

What are some common challenges faced in insurance claims processing, and how can new team members effectively manage them?

In insurance claims processing, new team members often encounter challenges such as handling high volumes of claims, interpreting complex policy language, and communicating effectively with policyholders and other stakeholders. To manage these challenges, it's important to develop strong organizational skills, stay detail-oriented, and proactively seek clarification when unsure about policy terms or procedures. Collaborating with experienced colleagues and taking advantage of ongoing training opportunities can also help new processors build confidence and efficiency in their daily tasks.

What is the difference between Insurance Claims Processing vs Insurance Adjuster?

AspectInsurance Claims ProcessingInsurance Adjuster
CredentialsTypically requires a high school diploma or equivalent; certifications like CPCU or AIC are commonRequires a high school diploma; certifications like AIC or state licensing often needed
Work EnvironmentOffice-based, processing claims via computer systemsField and office work, inspecting damages and interviewing claimants
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Primary FocusReviewing and processing insurance claims efficientlyAssessing damages and determining claim validity and payout

While both roles are essential in the insurance industry, Insurance Claims Processing focuses on handling and managing claims paperwork, whereas Insurance Adjusters evaluate damages and determine claim settlements. Understanding these differences helps job seekers identify the right career path within the insurance sector.

How to get a job as an insurance claims processor?

To become an insurance claims processor, candidates typically need a high school diploma or equivalent, with some roles preferring postsecondary training or certifications in insurance or claims processing. Relevant skills include attention to detail, communication, and familiarity with claims management software. Gaining experience through internships or entry-level positions can improve job prospects, and some employers may require background checks or specific licensing depending on the state or company policies.

Is insurance claims processing a stressful job?

Insurance claims processing can be a stressful job due to tight deadlines, high workload, and the need for accuracy in evaluating claims. It often requires strong attention to detail, communication skills, and the ability to handle difficult customer interactions, which can contribute to job-related stress.

What does an insurance claims processing do?

An insurance claims processor reviews and evaluates insurance claims to determine coverage and payout amounts. They verify policy details, gather necessary documentation, and ensure claims are processed accurately and efficiently, often using claims management software. Attention to detail and knowledge of insurance policies are essential for this role.

What are popular job titles related to Insurance Claims Processing jobs in Wisconsin?

For Insurance Claims Processing jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Insurance Claims Processing jobs in Wisconsin look for?

The top searched job categories for Insurance Claims Processing jobs in Wisconsin are:

What cities in Wisconsin are hiring for Insurance Claims Processing jobs?

Cities in Wisconsin with the most Insurance Claims Processing job openings:

Insurance Claims Processing jobs near you
Infographic showing various Insurance Claims Processing job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Insurance Claims Examiner II

Forest County Potawatomi Community

Crandon, WI

Full-time

Re-posted 29 days ago

Job description

Here’s what you’ll be doing:

Level II

Level III

1

Analyzes and processes minimum of 200 claims daily to determine plan liability; reviews payment Purchased Referred Care, medical, dental and vision claims

Analyzes and processes minimum of 400 claims to determine plan liability; reviews payment Purchased Referred Care, medical, dental and vision claims

2

Compiles, submits documents, and tracks claims for CHEF, (Catastrophic Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases, following current IHS guidelines and regulations

Compiles, submits documents, and tracks claims for CHEF, (Catastrophic Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases, following current IHS guidelines and regulations

3

Collaborates with the Eligibility team to ensure payer of last resort stance is utilized when handling Purchased Referred Care claims and payments

Collaborates with the Eligibility team to ensure payer of last resort stance is utilized when handling Purchased Referred Care claims and payments

4

Assists with other research and development projects as directed by Management; obtains and maintains necessary certification for Health Insurance Marketplace CAC

Provides training and guidance through expert knowledge of claims administration and adjudication to Insurance Department staff; responsible for the timely response to formal appeals from members, employees, clients and providers

5

Reviews, resolves and/or escalates Level 2 claims appeals; releases claims up to the designated draft authority for Level 2 Claims Examiner

Works with the Customer Service Coordinator to manage and provide direction to the utilization review and case management vendor; identifies and manages claims with potential subrogated recovery

6

Ensures that claims adjudication complies with all FCPID standards and protocols; reviews claims for possible abuses and/or fraud and bring to the attention of management

Oversees the repricing processes to ensure the integrity of the product; investigates claims referred by staff for possible abuse and fraud

What you’ll need to be successful:

Level II

Level III

1

High School Diploma or GED

High School Diploma or GED

2

Five (5) years of experience in medical claims processing

Five (5) years of experience in medical claims processing

3

Three (3) years in customer service

Three (3) years in customer service

4

Knowledge of Indian Health Service guidelines as it pertains to payment of medical providers and health benefits claims processing standards

Two (2) years in a lead or supervisory capacity

5

Knowledge of NCCI and CMS coding/billing standards, CPT-4, ICD-9, ICD-10, DRG and HCPS and medical terminology

Knowledge of Indian Health Service guidelines as it pertains to payment of medical providers and health benefits claims processing standards

6

Knowledge of insurance principles and/or procedures

Knowledge of NCCI and CMS coding/billing standards, CPT-4, ICD-9, ICD-10, DRG and HCPS and medical terminology

7

Skill in operating various word-processing, spreadsheets, and database software programs in a Windows environment

Knowledge of insurance principles and/or procedures

8

Must successfully pass all applicable background checks and drug screens

Skill in operating various word-processing, spreadsheets, and database software programs in a Windows environment

9

Must successfully pass all applicable background checks and drug screens

Benefits you’ll love:

  • Approximately 5 weeks of paid time off annually
  • 3 weeks of paid holidays
  • Premium free health insurance
  • Flexible spending accounts
  • Short term disability
  • Life insurance
  • 401k with match

Apply