Insurance Claims Examiner II
Crandon, WI · On-site
... medical, dental and vision claims 2 Compiles, submits documents, and tracks claims for CHEF ... Life insurance * 401k with match
Crandon, WI · On-site
... medical, dental and vision claims 2 Compiles, submits documents, and tracks claims for CHEF ... Life insurance * 401k with match
Crandon, WI · On-site
... medical, dental and vision claims 2 Compiles, submits documents, and tracks claims for CHEF ... Life insurance * 401k with match
WI · On-site
... medical, dental and vision claims 2 Compiles, submits documents, and tracks claims for CHEF ... Insurance Marketplace CAC Provides training and guidance through expert knowledge of claims ...
WI · On-site
... medical, dental and vision claims 2 Compiles, submits documents, and tracks claims for CHEF ... Insurance Marketplace CAC Provides training and guidance through expert knowledge of claims ...
Eau Claire, WI · On-site
$90K/yr
Profit Sharing Safe Driving Bonus Store Discount Insurance - Medical and Dental 401(k) Paid ... Class A CDL Proof of valid driver's license Current Medical Examiner's Certificate (DOT Medical ...
Eau Claire, WI · On-site
$90K/yr
Profit Sharing Safe Driving Bonus Store Discount Insurance - Medical and Dental 401(k) Paid ... Class A CDL Proof of valid driver's license Current Medical Examiner's Certificate (DOT Medical ...
Eau Claire, WI · On-site
$90K/yr
Profit Sharing Safe Driving Bonus Store Discount Insurance - Medical and Dental 401(k) Paid ... Class A CDL Proof of valid driver's license Current Medical Examiner's Certificate (DOT Medical ...
Eau Claire, WI · On-site
$90K/yr
Profit Sharing Safe Driving Bonus Store Discount Insurance - Medical and Dental 401(k) Paid ... Class A CDL Proof of valid driver's license Current Medical Examiner's Certificate (DOT Medical ...
Iron Ridge, WI · On-site
$75K - $80K/yr
Insurance - Medical (Full-Time) and Dental * 401(k) * Paid Time Off (Full-Time) * Paid Holidays ... Current Medical Examiner's Certificate (DOT Medical Card) • Excellent driving record • ...
Iron Ridge, WI · On-site
$75K - $80K/yr
Insurance - Medical (Full-Time) and Dental * 401(k) * Paid Time Off (Full-Time) * Paid Holidays ... Current Medical Examiner's Certificate (DOT Medical Card) • Excellent driving record • ...
Iron Ridge, WI · On-site
$75K - $80K/yr
Insurance - Medical (Full-Time) and Dental * 401(k) * Paid Time Off (Full-Time) * Paid Holidays ... Current Medical Examiner's Certificate (DOT Medical Card) • Excellent driving record • ...
Iron Ridge, WI · On-site
$75K - $80K/yr
Insurance - Medical (Full-Time) and Dental * 401(k) * Paid Time Off (Full-Time) * Paid Holidays ... Current Medical Examiner's Certificate (DOT Medical Card) • Excellent driving record • ...
Brookfield, WI · On-site
$20 - $24/hr
Prepare examination rooms and assist with medical procedures as directed. * Perform administrative tasks such as scheduling appointments, verifying insurance information, and managing patient records.
Brookfield, WI · On-site
$20 - $24/hr
Prepare examination rooms and assist with medical procedures as directed. * Perform administrative tasks such as scheduling appointments, verifying insurance information, and managing patient records.
Brookfield, WI · On-site
$20 - $24/hr
Prepare examination rooms and assist with medical procedures as directed. * Perform administrative tasks such as scheduling appointments, verifying insurance information, and managing patient records.
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Brookfield, WI · On-site
$20 - $24/hr
Prepare examination rooms and assist with medical procedures as directed. * Perform administrative tasks such as scheduling appointments, verifying insurance information, and managing patient records.
$20 - $24/hr
Prepare examination rooms and assist with medical procedures as directed. * Perform administrative tasks such as scheduling appointments, verifying insurance information, and managing patient records.
$20 - $24/hr
Prepare examination rooms and assist with medical procedures as directed. * Perform administrative tasks such as scheduling appointments, verifying insurance information, and managing patient records.
Waukesha, WI · Remote
$32.75 - $44.50/hr
Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* * ... Medical, Dental & Vision Insurance * Life and Disability Insurance * 401(k) plan * Paid time off
Waukesha, WI · Remote
$32.75 - $44.50/hr
Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* * ... Medical, Dental & Vision Insurance * Life and Disability Insurance * 401(k) plan * Paid time off
Waukesha, WI · On-site +1
$70K - $85K/yr
Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* * ... Medical, Dental & Vision Insurance * Life & disability Insurance * 401(k) plan * Paid holiday
Waukesha, WI · On-site +1
$70K - $85K/yr
Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* * ... Medical, Dental & Vision Insurance * Life & disability Insurance * 401(k) plan * Paid holiday
Waukesha, WI · On-site +1
$70K - $85K/yr
Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* * ... Medical, Dental & Vision Insurance * Life and Disability Insurance * 401(k) plan * Paid time off
Waukesha, WI · On-site +1
$70K - $85K/yr
Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* * ... Medical, Dental & Vision Insurance * Life and Disability Insurance * 401(k) plan * Paid time off
Janesville, WI · Hybrid
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
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Janesville, WI · Hybrid
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
Sun Prairie, WI · Hybrid
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
Quick apply
Sun Prairie, WI · Hybrid
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
Fond Du Lac, WI · Hybrid
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
Quick apply
Fond Du Lac, WI · Hybrid
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
Fond Du Lac, WI · On-site
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
Fond Du Lac, WI · On-site
Benefits: medical, dental, vision, HSA/FSA, life & AD&D insurance, short-term and long-term ... Prepares search/examination sheet, title commitments, policies and report of title received from ...
Milwaukee, WI · On-site
$33.92 - $50.88/hr
The Milwaukee County Medical Examiner's Office is charged with investigating and determining the ... Current Wisconsin Driver's License and access to a reliable insured vehicle; both maintained ...
New
Milwaukee, WI · On-site
$33.92 - $50.88/hr
The Milwaukee County Medical Examiner's Office is charged with investigating and determining the ... Current Wisconsin Driver's License and access to a reliable insured vehicle; both maintained ...
New
$33.92 - $50.88/hr
The Milwaukee County Medical Examiner's Office is charged with investigating and determining the ... Current Wisconsin Driver's License and access to a reliable insured vehicle; both maintained ...
New
$33.92 - $50.88/hr
The Milwaukee County Medical Examiner's Office is charged with investigating and determining the ... Current Wisconsin Driver's License and access to a reliable insured vehicle; both maintained ...
New
Waukesha, WI · On-site +1
$70K - $85K/yr
... Examiners, and other TRISTAR staff in the office; therefore, consistently being at work on time is ... Manages medical treatment and medical billing, authorizing as appropriate.* * Refers cases to ...
Waukesha, WI · On-site +1
$70K - $85K/yr
... Examiners, and other TRISTAR staff in the office; therefore, consistently being at work on time is ... Manages medical treatment and medical billing, authorizing as appropriate.* * Refers cases to ...
Waukesha, WI · On-site
$32.75 - $44.50/hr
... Examiners, and other TRISTAR staff in the office; therefore, consistently being at work on time is ... Manages medical treatment and medical billing, authorizing as appropriate.* * Refers cases to ...
Waukesha, WI · On-site
$32.75 - $44.50/hr
... Examiners, and other TRISTAR staff in the office; therefore, consistently being at work on time is ... Manages medical treatment and medical billing, authorizing as appropriate.* * Refers cases to ...
$62.8K is the 25th percentile. Wages below this are outliers.
$36.8K - $64.4K
27% of jobs
The median wage is $90.8K / yr.
$64.4K - $92K
24% of jobs
$92K - $119.6K
4% of jobs
$119.6K - $147.1K
3% of jobs
$147.1K - $174.7K
2% of jobs
$174.7K - $202.3K
1% of jobs
$202.3K - $229.9K
3% of jobs
$229.9K - $257.4K
6% of jobs
$263.5K is the 75th percentile. Wages above this are outliers.
$257.4K - $285K
17% of jobs
$285K - $312.6K
7% of jobs
$312.6K - $340.2K
4% of jobs
$36.8K
$166.3K
$340.2K
An Insurance Medical Examiner is a healthcare professional, often a physician or paramedic, responsible for conducting medical evaluations for life or health insurance applicants. They perform physical exams, collect medical histories, and obtain specimens like blood and urine for laboratory testing. Their findings help insurance companies assess an applicant's health risk and determine policy eligibility and premium rates.
Succeeding as an Insurance Medical Examiner requires a medical degree, licensure, thorough knowledge of clinical assessment, and experience in performing detailed physical examinations. Familiarity with electronic medical record (EMR) systems, diagnostic tools, and industry-standard reporting formats is essential. Strong attention to detail, objective judgment, and excellent written and verbal communication skills distinguish top professionals in this field. These abilities ensure accurate evaluations, clear documentation, and effective communication with insurance companies, all vital for fair and efficient risk assessment.
For Insurance Medical Examiner jobs in Wisconsin, the most frequently searched job titles are:
The top searched job categories for Insurance Medical Examiner jobs in Wisconsin are:

Full-time
Re-posted 5 hours ago
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:
Sourced by ZipRecruiter
501 - 1,000 Employees
Crandon, WI, US
1880