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Medical Claims Processing Jobs in Madison, WI (NOW HIRING)

Auxiant

Claims Examiner

Madison, WI

Responsible for processing medical claims and correspondence and handling customer service calls from members, providers, and clients. Essential Functions: * Process claims in a timely manner with ...

Auxiant

Claims Examiner

Madison, WI · On-site

Responsible for processing medical claims and correspondence and handling customer service calls from members, providers, and clients. Essential Functions: * Process claims in a timely manner with ...

Auxiant

Claims Examiner

Madison, WI · On-site +1

Responsible for processing medical claims and correspondence and handling customer service calls from members, providers, and clients. Essential Functions: * Process claims in a timely manner with ...

Auxiant

Claims Examiner

Madison, WI

Responsible for processing medical claims and correspondence and handling customer service calls from members, providers, and clients. Essential Functions: * Process claims in a timely manner with ...

PacificSource

Claims Team Leader

Oregon, WI · On-site

$51 - $81/hr

Oversee and assist with review and research of medical and dental claims and determine coverage based on contract, provider status and claims processing guidelines. Investigate and settle claims ...

New

Imedica

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 ...

CareOregon, Inc.

Payment Integrity Analyst

Oregon, WI · On-site

$90.92/hr

Knowledge and skill in using claims management systems, editing software and medical coding. Skills and Abilities * Solid understanding of complex claims processing and payment integrity/payment ...

Acrisure

Claims Specialist

Middleton, WI · On-site

$50K - $55K/yr

Communicate with injured workers, employers, medical providers, attorneys, and other stakeholders throughout the claims process * Maintain accurate and timely documentation within the claims ...

Progressive

Claims Adjuster Trainee

Mcfarland, WI · Hybrid

$54K - $57K/yr

... the claims process from start to finish. You'll have the support of a collaborative team and ... Medical, dental & vision, including free preventative care * Wellness & mental health programs

Progressive

Claims Adjuster Trainee

Middleton, WI · Hybrid

$54K - $57K/yr

... the claims process from start to finish. You'll have the support of a collaborative team and ... Medical, dental & vision, including free preventative care * Wellness & mental health programs

Mercy Health Corporation

Internal Auditor

Janesville, WI · On-site

$58K - $94K/yr

Evaluate claims processing activities for adherence to industry best practices, federal and state ... Medical, Dental, Vision * Life & Disability Insurance * FSA/HSA Options * Generous, accruing paid ...

Mercyhealth

Internal Auditor

Janesville, WI · On-site

$58K - $94K/yr

Evaluate claims processing activities for adherence to industry best practices, federal and state ... Medical, Dental, Vision * Life & Disability Insurance * FSA/HSA Options * Generous, accruing paid ...

Mercyhealth

Internal Auditor

Janesville, WI

$58K - $94K/yr

Evaluate claims processing activities for adherence to industry best practices, federal and state ... Medical, Dental, Vision * Life & Disability Insurance * FSA/HSA Options * Generous, accruing paid ...

Rural Mutual Insurance

Desk Auto Claims Adjuster

Madison, WI · On-site +1

$49K - $65K/yr

... processes, and valuation methods. • Experience evaluating liability and handling minor bodily ... medical payment exposures preferred. • Professional designations such as AIC or CPCU preferred ...

Sedgwick

Claims Representative, Auto

Madison, WI · On-site

$50K - $55K/yr

Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ... A comprehensive benefits package is offered including but not limited to, 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 Sep 6, 2026, the average hourly pay for medical claims processing in Madison, WI is $19.62, 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 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.

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 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.

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.

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 attention to detail, knowledge of medical billing and coding, and familiarity with claims processing software; certifications such as CPC or CPC-H can enhance job prospects.

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 or certification in medical billing and coding. Relevant skills include attention to detail, knowledge of insurance policies, and proficiency with claims processing software; certifications like Certified Professional Coder (CPC) can improve job prospects. Entry-level positions often require basic computer skills and understanding of healthcare terminology, with on-the-job training provided for specific systems used by employers.

What are popular job titles related to Medical Claims Processing jobs in Madison, WI?

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

What job categories do people searching Medical Claims Processing jobs in Madison, WI look for?

The top searched job categories for Medical Claims Processing jobs in Madison, WI are:

Medical Claims Processing jobs near you
Infographic showing various Medical Claims Processing job openings in Madison, WI as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 16% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $40,808 per year, or $19.6 per hour.

Claims Examiner

Auxiant

Madison, WI

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

Description


https://www.auxiant.com/


Auxiant's Mission Statement and Core Values


Mission:
An Independent TPA investing in People and Innovation to deliver expert-driven experiences with REAL Results.


Core Values: Independent Solutions. REAL Results
Respect
Empowerment
Agility
Leadership


Be part of a growing and prospering company as a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans with offices in Cedar Rapids, IA, Madison and Milwaukee, WI. Auxiant is a fast-growing,progressive company offering an excellent wage and benefit package.


Job Summary: Responsible for processing medical claims and correspondence and handling customer service calls from members, providers, and clients.


Essential Functions:

  • Process claims in a timely manner with acceptable accuracy
  • Answer inbound phone calls from members and providers.
  • Handle correspondence from members and providers in a timely manner.
  • Analyze self-funded health plans and use plan language to correspond to necessary inquiries, both verbally and written.
  • Interpret plan design and language to analyze claim edits.
  • Point of contact for clients and members.
  • Work Customer Service Tickets.

Nonessential Functions:

  • Other duties as assigned or appropriate

Education/Qualifications:

  • Familiarity with ICD-10 and CPT coding
  • Understanding of medical claims processing guidelines
  • Proficient PC skills including email, record keeping, routine database activity, word processing, spreadsheet and 10-key
  • QicLink experience
  • Medical Terminology
  • High school diploma and 1-2 years related experience; or equivalent combination of education and experience

*Full benefits including: Medical, Dental, Vision, Flexible Spending, Gym Membership Reimbursement, Life Insurance, LTD, STD, 401K, 3 weeks vacation, 9 paid holidays, casual dress code and more


Job Type: Full-time


Schedule:

  • 8 hour shift
  • Day shift
  • Monday to Friday


Work Location: In person

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