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Medical Claims Processing Jobs in Wisconsin (NOW HIRING)

battleface

Claims Adjuster

Stevens Point, WI

Assess the need for medical management and escalate appropriately * Process bills in accordance ... A belief that claims processing should enhance, not hinder, the customer experience * Strength in ...

battleface

Claims Adjuster

Stevens Point, WI · On-site

Assess the need for medical management and escalate appropriately * Process bills in accordance ... A belief that claims processing should enhance, not hinder, the customer experience * Strength in ...

Medica

Director, Claims Operations

Madison, WI · On-site

$113K - $194K/yr

Provide end-to-end oversight of claims processing from intake through adjudication and payment ... Medica offers a generous total rewards package that includes competitive medical, dental, vision ...

Network Health, Inc

Claims Analyst II

Menasha, WI · On-site +1

Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while ...

Network Health

Claims Analyst II

Menasha, WI · On-site +1

Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while ...

Network Health, Inc

Claims Analyst II

Brookfield, WI · On-site +1

Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while ...

Network Health

Claims Analyst II

Brookfield, WI · On-site +1

Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while ...

Imedica

Director, Claims Operations

Madison, WI

$113K - $194K/yr

Provide end-to-end oversight of claims processing from intake through adjudication and payment ... Medica offers a generous total rewards package that includes competitive medical, dental, vision ...

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Medical Claims Processing information

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How much do medical claims processing jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for medical claims processing in Wisconsin is $19.65, according to ZipRecruiter salary data. Most workers in this role earn between $17.45 and $21.83 per hour, depending on experience, location, and employer.

What are some common challenges faced in medical claims processing, and how can professionals address them?

Medical claims processors often encounter challenges such as handling complex insurance policies, navigating frequent regulatory changes, and ensuring the accuracy of coding and billing information. To address these issues, professionals need to stay updated with industry regulations, maintain strong attention to detail, and communicate effectively with healthcare providers and insurance companies. Ongoing training and the use of specialized software can also help streamline workflows and minimize errors, making the process more efficient.

What is medical claims processing?

Medical claims processing is the administrative procedure of reviewing, validating, and handling healthcare claims submitted by providers to insurance companies or payers for reimbursement. This process involves checking the accuracy of the submitted information, verifying patient eligibility and coverage, and ensuring that services are medically necessary and properly coded. Claims processors work to approve, deny, or request additional information to resolve claims, ultimately ensuring that healthcare providers receive payment and patients are billed accurately.

Do you need a degree to be a medical claims processor?

A degree is not typically required to become a medical claims processor, but employers often prefer candidates with a high school diploma or equivalent. Relevant skills include knowledge of medical billing, coding, and claims processing software, and some certifications can enhance job prospects.

What is the difference between Medical Claims Processing vs Medical Billing?

AspectMedical Claims ProcessingMedical Billing
CredentialsTypically requires knowledge of insurance policies and claims proceduresRequires understanding of coding and billing practices
Work EnvironmentOften in insurance companies, healthcare providers, or claims processing centersPrimarily in healthcare provider offices or billing companies
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsHospitals, clinics, medical practices, billing services

Medical Claims Processing focuses on reviewing and submitting insurance claims for reimbursement, ensuring compliance with policies. Medical Billing involves coding patient services and generating bills for patients and insurers. While related, Claims Processing emphasizes claim review and approval, whereas Billing centers on creating accurate invoices for services rendered.

What are the key skills and qualifications needed to thrive as a medical claims processor, and why are they important?

To thrive as a Medical Claims Processor, you need a solid understanding of medical terminology, insurance policies, and claims procedures, often supported by a high school diploma or associate degree. Familiarity with claims management software, healthcare coding systems (ICD-10, CPT), and electronic health record (EHR) systems is typically required. Attention to detail, strong organizational skills, and effective communication help ensure accuracy and timely processing. These skills are crucial for minimizing errors, reducing claim denials, and supporting efficient healthcare reimbursement processes.

How to get a job as a medical claims processor?

To become a medical claims processor, candidates typically need a high school diploma or equivalent, with some roles preferring postsecondary training in healthcare administration or related fields. Relevant skills include attention to detail, knowledge of medical billing and coding, and proficiency with claims processing software. Certification such as the Certified Medical Reimbursement Specialist (CMRS) can improve job prospects, and previous experience in healthcare or insurance is often beneficial.

What are the most commonly searched types of Medical Claims Processing jobs in Wisconsin?

The most popular types of Medical Claims Processing jobs in Wisconsin are:

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

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

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

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

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

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

Medical Claims Processing jobs near you
Infographic showing various Medical Claims Processing job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $40,872 per year, or $19.6 per hour.

Insurance Claims Examiner II

Forest County Potawatomi

WI • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 24 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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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