In coordination with the CMO and Directors of Health Management and QI and Disease Management ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines
In coordination with the CMO and Directors of Health Management and QI and Disease Management ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines
In coordination with the CMO and Directors of Health Management and QI and Disease Management ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines
In coordination with the CMO and Directors of Health Management and QI and Disease Management ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines
In coordination with the CMO and Directors of Health Management and QI and Disease Management ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines
In coordination with the CMO and Directors of Health Management and QI and Disease Management ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines
Accounts Receivable Specialist
Green Bay, WI · On-site
$19.75 - $26/hr
Accounts Receivable - Medical Billing Specialist On Site - Green Bay, WI POSITION SUMMARY: Apply ... Research and reconcile unpaid or underpaid claims, including aged claims * Inform manager of any ...
Quick apply
Accounts Receivable Specialist
Green Bay, WI · On-site
$19.75 - $26/hr
Accounts Receivable - Medical Billing Specialist On Site - Green Bay, WI POSITION SUMMARY: Apply ... Research and reconcile unpaid or underpaid claims, including aged claims * Inform manager of any ...
Accounting Manager
Neenah, WI · On-site
$95K - $115K/yr
Ensure that all manufacturer accounts including warranty claims, rebates, interest, protection, and ... Medical, Dental, Vision, Short and Long Term Disability, and Life Insurance (for FT team members)
Accounting Manager
Neenah, WI · On-site
$95K - $115K/yr
Ensure that all manufacturer accounts including warranty claims, rebates, interest, protection, and ... Medical, Dental, Vision, Short and Long Term Disability, and Life Insurance (for FT team members)
Accounting Manager
Neenah, WI · On-site
$95K - $115K/yr
Ensure that all manufacturer accounts including warranty claims, rebates, interest, protection, and ... Medical, Dental, Vision, Short and Long Term Disability, and Life Insurance (for FT team members)
Accounting Manager
Neenah, WI · On-site
$95K - $115K/yr
Ensure that all manufacturer accounts including warranty claims, rebates, interest, protection, and ... Medical, Dental, Vision, Short and Long Term Disability, and Life Insurance (for FT team members)
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing: Handle timely processing of warranty claims for each franchise or ... Paperwork Management: Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing: Handle timely processing of warranty claims for each franchise or ... Paperwork Management: Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Quick apply
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Warranty Claims Processing : Handle timely processing of warranty claims for each franchise or ... Paperwork Management : Complete and verify all necessary warranty paperwork, ensuring proper ...
Responsibilities include assisting with healthcare compliance matters, supporting medical staff and ... Assists with litigation and claims management, including legal hold administration, document ...
Responsibilities include assisting with healthcare compliance matters, supporting medical staff and ... Assists with litigation and claims management, including legal hold administration, document ...
Accounts Receivable Specialist - Remote
Appleton, WI · On-site +1
$19.75 - $26/hr
... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist identifies and resolves denials, underpayments, payment delays, and no-response claims while ensuring ...
Accounts Receivable Specialist - Remote
Appleton, WI · On-site +1
$19.75 - $26/hr
... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist identifies and resolves denials, underpayments, payment delays, and no-response claims while ensuring ...
Accounts Receivable Specialist
Appleton, WI · On-site
$19.75 - $26/hr
... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist identifies and resolves denials, underpayments, payment delays, and no-response claims while ensuring ...
Accounts Receivable Specialist
Appleton, WI · On-site
$19.75 - $26/hr
... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist identifies and resolves denials, underpayments, payment delays, and no-response claims while ensuring ...
Accounts Receivable Specialist - Remote
Appleton, WI · On-site +1
$19.75 - $26/hr
... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist identifies and resolves denials, underpayments, payment delays, and no-response claims while ensuring ...
Accounts Receivable Specialist - Remote
Appleton, WI · On-site +1
$19.75 - $26/hr
... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist identifies and resolves denials, underpayments, payment delays, and no-response claims while ensuring ...
Pharmacy Manager - Sign-On Bonus Available
Little Chute, WI · On-site
$67.05 - $90.55/hr
Refers to the medical provider, as needed, to ensure medication is taken correctly, health needs ... Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient ...
Pharmacy Manager - Sign-On Bonus Available
Little Chute, WI · On-site
$67.05 - $90.55/hr
Refers to the medical provider, as needed, to ensure medication is taken correctly, health needs ... Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient ...
Pharmacy Manager - Sign-On Bonus Available
Little Chute, WI · On-site
$64.50 - $75.75/hr
Refers to the medical provider, as needed, to ensure medication is taken correctly, health needs ... Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient ...
Pharmacy Manager - Sign-On Bonus Available
Little Chute, WI · On-site
$64.50 - $75.75/hr
Refers to the medical provider, as needed, to ensure medication is taken correctly, health needs ... Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient ...
... Medical Industries. Job Summary 1. Focal point for customer/buyer communication and interface ... claims. 5. Development and growth of the Program: * Create and manage program bookings and provide ...
... Medical Industries. Job Summary 1. Focal point for customer/buyer communication and interface ... claims. 5. Development and growth of the Program: * Create and manage program bookings and provide ...
... Medical Industries. Job Summary 1. Focal point for customer/buyer communication and interface ... claims. 5. Development and growth of the Program: * Create and manage program bookings and provide ...
... Medical Industries. Job Summary 1. Focal point for customer/buyer communication and interface ... claims. 5. Development and growth of the Program: * Create and manage program bookings and provide ...
Medical Claims Manager information
See Appleton, WI salary details
$34.1K - $43.4K
4% of jobs
$43.4K - $52.6K
4% of jobs
$52.6K - $61.8K
10% of jobs
$65.4K is the 25th percentile. Wages below this are outliers.
$61.8K - $71.1K
18% of jobs
$71.1K - $80.3K
12% of jobs
The median wage is $81.8K / yr.
$80.3K - $89.5K
13% of jobs
$89.5K - $98.7K
14% of jobs
$99.1K is the 75th percentile. Wages above this are outliers.
$98.7K - $108K
12% of jobs
$108K - $117.2K
7% of jobs
$117.2K - $126.4K
4% of jobs
$126.4K - $135.6K
2% of jobs
$34.1K
$85.7K
$135.6K
How much do medical claims manager jobs pay per year?
As of Sep 2, 2026, the average yearly pay for medical claims manager in Appleton, WI is $85,729.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,300.00 and $102,500.00 per year, depending on experience, location, and employer.
What does a medical claims manager do?
A Medical Claims Manager oversees the processing of insurance claims related to healthcare services. They ensure that claims are handled efficiently, accurately, and in compliance with industry regulations. Their responsibilities include supervising claims staff, reviewing and resolving complex claims issues, and coordinating with healthcare providers and insurance companies. Medical Claims Managers also work to identify and prevent fraudulent claims and improve overall claims processing procedures.
What are the key skills and qualifications needed to thrive as a medical claims manager?
To thrive as a Medical Claims Manager, you need a strong background in healthcare administration, claims processing, and knowledge of insurance regulations, typically supported by a bachelor's degree in a related field. Familiarity with claims management systems, billing software, and certification such as Certified Professional Coder (CPC) are often required. Exceptional attention to detail, problem-solving abilities, and effective communication set top performers apart. These skills ensure accurate claims processing, regulatory compliance, and efficient resolution of disputes, which are critical for organizational success.
What are some common challenges medical claims managers face when overseeing claims processing teams?
Medical Claims Managers often encounter challenges such as keeping up with changing healthcare regulations, ensuring accurate and timely claims processing, and managing workflow during periods of high claim volume. They must also address discrepancies or denials efficiently and provide ongoing training to team members to maintain compliance and quality standards. Effective communication with insurance carriers, healthcare providers, and internal teams is crucial to resolving issues and streamlining operations.
What are the most commonly searched types of Medical Claims jobs in Appleton, WI?
The most popular types of Medical Claims jobs in Appleton, WI are:
What are popular job titles related to Medical Claims Manager jobs in Appleton, WI?
For Medical Claims Manager jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Medical Claims Manager jobs in Appleton, WI look for?
The top searched job categories for Medical Claims Manager jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Medical Claims Manager jobs?
Cities near Appleton, WI with the most Medical Claims Manager job openings:
Full-time
Re-posted 22 days ago
Network Health rating
7.9
Based on 5 frontline employees who took The Breakroom Quiz
187th of 315 rated insurance
Job description
In support of the CMO, the Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health (NH) members. This individual will be chair of at least 3 committees related to quality and accreditation.
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). Travel is required occasionally for the position.
Hours: 0.3 FTE, 24 hours per pay period, 8am - 5pm Friday through Sunday
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:
- Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers
- Participate in oversight and clinical decision making of the UM program, including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards
- Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes
- Provide medical consultation as requested for:
- Medical/legal issues
- Member grievance procedures
- Development and implementation of new benefit packages and the interpretation of covered benefits in NHP contracts
- Medical issues related to contract negotiations with health care providers
- Determining if services to members/enrollees meet medical criteria
- Promote positive relationship between NHP and medical community
- Serve as liaison between NHP and providers regarding matters of medical policy and medical administration
- Serve as spokesperson for NHP in the medical community and maintains appropriate contact with professional health care organizations
- Participates in the ongoing recruitment of plan physicians.
- Respond to physicians and other provider inquiries and complaints within established guidelines of the Executive Committee and Board of Directors
- Assist in the development of appropriate medical guidelines and parameters for claims review
- Assist in the training of NHP staff on matters relating to medical guidelines
- Oversight responsibility for monitoring and evaluating Medicare Special Needs Plan Model of Care effectiveness
- Perform second level review of provider appeals and disputes
- Serve on committees as coordinated with the CMO
- Assist in strategic planning targeted towards plan growth initiatives
Job Requirements:
- Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction
Member in good standing of the local medical community. An active practitioner of medicine in the NHP service areas
Must possess a thorough knowledge of the health professional and facilities and standards of practice of medicine in NHP’s service area
Must possess sufficient medical experience and other experience, including knowledge of the Medicare program, to review organization determinations involving medical necessity
- Board certified in an ABMS medical specialty required
Network Health is an Equal Opportunity Employer
About Network Health
Sourced by ZipRecruiter
Industry
Insurance services
Company size
201 - 500 Employees
Headquarters location
Menasha, WI, US
Year founded
1982