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Medical Claims Processing Jobs in Wisconsin (NOW HIRING)

Network Health WI

Claims Analyst II

Menasha, WI · On-site

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

SQL/ETL Developer I - Encounter

Menasha, WI · On-site +1

$52.25 - $68.25/hr

... core claims processing system, related data integrations, vendor extracts and reporting. This ... Experience with medical claims and EDI * High degree of experience with relational database design ...

Network Health

SQL/ETL Developer I - Encounter

Menasha, WI · On-site +1

$52.25 - $68.25/hr

... core claims processing system, related data integrations, vendor extracts and reporting. This ... Experience with medical claims and EDI * High degree of experience with relational database design ...

Network Health

SQL/ETL Developer I - Encounter

Brookfield, WI · On-site +1

$48.25 - $63.25/hr

... core claims processing system, related data integrations, vendor extracts and reporting. This ... Experience with medical claims and EDI * High degree of experience with relational database design ...

Network Health

SQL/ETL Developer I - Encounter

Brookfield, WI · On-site +1

$48.25 - $63.25/hr

... core claims processing system, related data integrations, vendor extracts and reporting. This ... Experience with medical claims and EDI * High degree of experience with relational database design ...

Network Health WI

SQL/ETL Developer I - Encounter

Menasha, WI · On-site

$52.25 - $68.25/hr

Develop, test, and implement data change scripts to support the claims processing system * Consult ... Experience with medical claims and EDI * High degree of experience with relational database design ...

Great American Insurance Group

$20 - $27/hr

Verify coverage, process claim-related transactions, and support payment and financial processing ... Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental ...

Dulyhealthandcare

$128K/yr

Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance ... Prior experience with the health care claims process and electronic claims payment systems such as ...

Vizance, Inc

Senior Claims Advisor

Hartland, WI · On-site

This individual is central to both the proactive and reactive claims processes and serves as a ... Comprehensive employee benefits package including medical, dental, vision, life, and disability ...

Vizance

Senior Claims Advisor

Hartland, WI · On-site

This individual is central to both the proactive and reactive claims processes and serves as a ... Comprehensive employee benefits package including medical, dental, vision, life, and disability ...

Vizance, Inc.

Senior Claims Advisor

Hartland, WI

This individual is central to both the proactive and reactive claims processes and serves as a ... Comprehensive employee benefits package including medical, dental, vision, life, and disability ...

HUDSON PHYSICIANS SC

Medical Billing Specialist

Hudson, WI · Remote

$18.75 - $24.25/hr

... related to claims processing. \tMaintain all records for assigned insurance encounter types ... Knowledge of medical terminology and healthcare insurance. 5. Good grammar, spelling and ...

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All JobsMedical Claims Processing JobsMedical Claims Processing Jobs in Wisconsin

Medical Claims Processing information

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How much do medical claims processing jobs pay per hour?

As of Aug 17, 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.

Claims Analyst II

Network Health WI

Menasha, WI • On-site

Full-time

Re-posted 29 days ago

Job description

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team.
We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following:
  • Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.
  • Resolve claims and related issues in compliance with policy provisions.
  • Compare claims applications and provider statements with policy files and other records to ensure completeness and validity.
  • Process payments for claims that are approved.

This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health.
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), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.
Hours: 1.0 FTE, 40 hours per week between 8am-5pm Monday through Friday.
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:
  • Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality.
  • Reviews claims to ensure compliance with proper billing standards and completeness of information.
  • Obtains additional information from appropriate person and/or agency as needed.
  • Maintains department quality standards.
  • Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality standards.
  • Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly.
  • Investigates and resolves pending claims in accordance with established time frames. Identifies claims needing to be pended or suspended. Reviews pending claims timely and denies claims after established time frame is reached without resolution.
  • Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed.
  • Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc.
  • Reviews home office claims for payment up to $18,000.00.
  • Reviews claims for re-pricing. Enters eligible claim data into appropriate WRAP network re-pricing website. Overrides claims allowed amounts to apply internal/external discounts.
  • Appropriately documents attributes and memos for pertinent information related to claims payment.
  • Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract.
  • Performs other duties and responsibilities as assigned.

Job Requirements:
  • High school diploma or equivalent preferred.
  • 2-4 years claims processing experience required
  • Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation.
  • Past experience using QNXT™ Claims Workflow a plus
  • Prior experience with ACA, Medicaid, or similar health plans preferred.
  • Coding experience preferred.

Network Health is an Equal Opportunity Employer.
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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