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Insurance Claims Processing Jobs in Whitewater, WI

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Insurance Claims Processing information

See Whitewater, WI salary details

$11

$22

$33

How much do insurance claims processing jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for insurance claims processing in Whitewater, WI is $22.01, according to ZipRecruiter salary data. Most workers in this role earn between $17.98 and $25.10 per hour, depending on experience, location, and employer.

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 cities near Whitewater, WI are hiring for Insurance Claims Processing jobs?

Cities near Whitewater, WI with the most Insurance Claims Processing job openings:

Insurance Claims Processing jobs near you
Infographic showing various Insurance Claims Processing job openings in Whitewater, WI as of June 2026, with employment types broken down into 11% As Needed, 52% Full Time, 32% Part Time, and 5% Nights. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $45,780 per year, or $22 per hour.

Workers Compensation Claims Examiner III

Tristar Insurance

Waukesha, WI • On-site

$32.75 - $44.50/hr

Full-time

Re-posted 21 days ago

Job description

POSITION SUMMARY:  Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. 

This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore, consistently being at work on time is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

  • Effectively manages a caseload of 150 or fewer workers’ compensation files, including complex claims.*
  • Initiates and investigates promptly.*
  • Determines compensability of claims and administers benefits based upon state law and following established Company guidelines.*
  • Manages medical treatment and medical billing, authorizing as appropriate.*
  • Refers cases to outside defense counsel. Directs and manages as appropriate.* 
  • Communicates with claimants, providers, and vendors regarding claims issues.*
  • Computes and sets reserves within Company guidelines. Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.*
  • Settles and finalizes all claims and obtains authority as designated.*
  • Maintains diary system for case review and documents file to reflect the status and work performed on the file.*
  • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.*
  • Involves TRISTAR loss control staff when appropriate.*
  • Adheres to all Company policies and procedures.*
  • Conducts file reviews independently.*
  • Other duties as assigned.

* Essential job function.

EQUIPMENT OPERATED/USED:  Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING:  Appropriate office attire

QUALIFICATIONS REQUIRED:

Education/Experience:  Bachelor’s degree in a related field (preferred); three (3) or more years of related experience; or equivalent combination of education and experience.

Knowledge, Skills, and Abilities:

  • Technical knowledge of statutory regulations and medical terminology.
  • Analytical skills.
  • Excellent written and verbal communication skills, including conveying technical details to claimants, clients, and staff.
  • Ability to interact with persons at all levels in the business environment.
  • Ability to independently and effectively manage very complex claims.
  • Proficient in Word and Excel (preferred).

Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements]

 
 
 
 

                              MENTAL AND PHYSICAL REQUIREMENTS

1. MENTAL EFFORT

a.       Reasoning development:

           Follow one- or two-step instructions; routine, repetitive task.

         Carry out detail but uninvolved written or verbal instructions; deal with a few concrete                            variables.

         Follow written, verbal, or diagrammatic instructions; several concrete variables.

 X      Solve practical problems; variety of variables with limited standardization; interpret instructions.

         Logical or scientific thinking to solve problems; several abstract and concrete variables.

         Wide range of intellectual and practical problems; comprehend most obscure concepts.

b.       Mathematical development:

          Simple additional and subtraction; copying figures, counting, and recording.

          Add, subtract, multiply, and divide whole numbers.

 X      Arithmetic calculations involving fractions, decimals, and percentages.

          Arithmetic, algebraic, and geometric calculations.

          Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

          Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.

c.       Language development:

          Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

          Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

          Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

 X      Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

          Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

2. PHYSICAL EFFORT

a.       Physical activity required to perform the job:

          Sedentary work:  Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

 X      Light work:

a.    Exerting up to 20 pounds of force occasionally

b.    Exerting up to 10 pounds frequently

c.    Exerting a negligible amount of force constantly to move objects

          (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

          Medium work:

a.    Exerting up to 50 pounds of force occasionally

b.    Exerting up to 20 pounds of force frequently

c.    Exerting up to 10 pounds of force constantly to move objects

          Heavy work:

a.    Exerting up to 100 pounds of force occasionally

b.    Exerting up to 50 pounds of force frequently

c.    Exerting up to 20 pounds of force constantly to move objects

          Very heavy work:

a.    Exerting in excess of 100 pounds of force occasionally

b.    Exerting in excess of 50 pounds of force constantly to move objects

c.    Exerting in excess of 20 pounds of force constantly to move objects

  1. Visual requirements necessary to perform the job:

         Far vision:  clarity of vision at 20 feet or more

 X      Near vision:  clarity of vision at 20 inches or less

 X      Mid-range vision:  clarity of vision at distances of more than 20 inches and less than 20 feet

         Depth perception:  the ability to judge distance and space relationships, so as to see objects where and as they actually are

         Color vision:  ability to identify and distinguish colors

         Field of vision:  ability to observe an area up or down or to the right or left while eyes are fixed on a given point

2. PHYSICAL EFFORT (cont.)

    FREQUENCY

c.    Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

        Climbing:      Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is  emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.

        Balancing:     Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.

 X    Stooping:       Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

 X    Kneeling:       Bending legs at knee to come to a rest on knee or knees.

 X    Crouching:    Bending the body downward and forward by bending legs and spine.

       Crawling:      Moving about on hands and knees or hands and feet.

 X    Reaching:      Extending hand(s) and arm(s) in any direction.

 X    Standing:       Particularly for sustained periods of time.

 X    Walking:       Moving about on foot to accomplish tasks, particularly for long distances.

 X    Pushing:        Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.

 X    Pulling:         Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.

        Foot

       Motion:          Using feet to push pedals.

 X    Lifting:          Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

 X    Fingering:     Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.

 X    Grasping:      Applying pressure to an object with the fingers and palm.

Occasionally

Occasionally

Occasionally

Occasionally

Occasionally

Occasionally

Occasionally

Occasionally

Frequently

Frequently

Occasionally

    

2. PHYSICAL EFFORT (cont.)                   

      FREQUENCY

 X    Talking:         Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

 X    Hearing:        Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.

       Feeling:         Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

 X    Repetitive      Substantial movements (motions) of the wrists, hands,

       Motion:         and/or fingers.

Frequently

Frequently

Frequently

3. WORKING CONDITIONS

Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. 

       WORKING CONDITION

           ENVIRONMENTAL

                     FACTOR

           NATURE/REASON

               OF EXPOSURE

                FREQUENCY

Dirt/Dust

Noise

Temperature extremes

Dampness

Vibrations

Equipment movement hazard

Chemicals/solvents

Electrical shock

Significant work pace/pressure

Odors/Fumes

Other (specify):                              

    

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