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Remote Claims Processing Jobs in Wisconsin (NOW HIRING)

WPS

Appeals Claims Processor

Madison, WI · On-site +1

$19.60/hr

This is a 100% remote opportunity within any of our approved remote worker states. We are open to ... processing role. * Knowledge of TRICARE Policy Manuals and eligibility guidelines, claims ...

Globe Life American Income Division

$15.50 - $21/hr

Remote Client Representative Location: 100% Remote | Schedule: Flexible We have proudly served ... Support policyholders with inquiries, policy updates, and claims processing. * Foster Relationship ...

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Remote Claims Processing information

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$12

$19

$26

How much do remote claims processing jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for remote claims processing in Wisconsin is $19.34, according to ZipRecruiter salary data. Most workers in this role earn between $16.49 and $20.87 per hour, depending on experience, location, and employer.

What are some common challenges faced in remote claims processing roles, and how can they be effectively managed?

Remote claims processing professionals often encounter challenges such as managing high volumes of claims, maintaining clear communication with team members, and ensuring data security while working from home. Effective time management and strong organizational skills are key to handling large workloads efficiently. Regular check-ins with supervisors and using secure, company-approved communication tools can help maintain collaboration and protect sensitive information. Many organizations also provide training and support to help remote processors stay up-to-date with changing regulations and best practices.

What are the key skills and qualifications needed to thrive as a Remote Claims Processor, and why are they important?

To thrive as a Remote Claims Processor, you need a strong understanding of insurance policies, attention to detail, and relevant experience or education in insurance or finance. Familiarity with claims management software, electronic document systems, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent communication, time management, and problem-solving abilities help you stand out, especially when working independently. These skills ensure accurate, timely claims resolutions and effective collaboration with clients and colleagues in a remote environment.

What is remote claims processing?

Remote claims processing is the evaluation and handling of insurance claims by professionals who work from locations outside of a traditional office, often from home. These processors review claim submissions, verify information, assess coverage, and authorize payments or request additional information. Remote claims processors use secure online systems and communication tools to collaborate with colleagues and clients. This role requires strong attention to detail, confidentiality, and proficiency with digital platforms. Many insurance companies now offer remote claims processing positions to increase flexibility and efficiency.

What is the difference between Remote Claims Processing vs Remote Claims Adjuster?

AspectRemote Claims ProcessingRemote Claims Adjuster
CredentialsTypically requires insurance or claims processing certificationsRequires insurance licenses and adjuster certifications
Work EnvironmentHome-based, administrative settingHome-based or field, investigative and evaluative tasks
Industry UsageInsurance companies, third-party administratorsInsurance companies, public adjusting firms
Job FocusProcessing claims, data entry, customer serviceInvestigating claims, assessing damages, settlement negotiations

Remote Claims Processing and Remote Claims Adjuster roles share similarities in industry and work environment but differ in job focus and required credentials. Claims processors handle administrative tasks and data entry, while claims adjusters evaluate damages and negotiate settlements. Both roles are essential in the insurance industry and often require specialized certifications.

What are popular job titles related to Remote Claims Processing jobs in Wisconsin? For Remote Claims Processing jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Claims Processing jobs in Wisconsin look for? The top searched job categories for Remote Claims Processing jobs in Wisconsin are:
What cities in Wisconsin are hiring for Remote Claims Processing jobs? Cities in Wisconsin with the most Remote Claims Processing job openings:
Remote Claims Processing jobs near you
Appeals Claims Processor

Appeals Claims Processor

WPS Health Solutions

Madison, WI • On-site, Remote

$19.60/hr

Full-time

Medical, Dental, Retirement, PTO

Posted 4 days ago

Job description

U.S. citizenship is required for this position due to Department of Defense restrictions.


The Appeals Claims Processor is responsible for reviewing and making determinations on MVH appealable denials, from receipt through resolution in accordance with MVH regulations, guidelines, quality standards, and contractual requirements. The role works closely with the Nursing team to support and discuss medical decision-making.

 Additional Information

  • Start Date: June 30, 2026
  • Starting Hourly Rate: $19.60/hour and may vary based on county SCA rates.
  • Training Location/Schedule: On the job training – 1st Shift
  • Work Location: This is a 100% remote opportunity within any of our approved remote worker states.

We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

In this role you will:

  • Process Medical and Factual Appeals received by Providers, Beneficiaries and DHA.
  • Translate, research, and verify claims information to determine if all requirements have been met.
  • Accountable for CNOTE completion, Summary Log creation, calculation of amounts in dispute, and sending determination letters.
  • Review incoming Appeals mail to ensure it is being submitted to the appropriate team.
  • Initiate adjustments, reprocesses and serve as resource for other teams.
  • Access patient/sponsor files and update information accordingly.

Minimum Qualifications

  • U.S. citizenship is required for this position due to Department of Defense restrictions.
  • High School Diploma or GED or equivalent experience.
  • 1 or more years of experience in a claims processing role.
  • Knowledge of TRICARE Policy Manuals and eligibility guidelines, claims adjudication procedures and MVH system programs.
  • Ability to effectively utilize available resources to further research and verify claims.
  • Strong written communication skills.
  • Demonstrates the ability to work independently and take initiative.

 Preferred Qualifications

  • 2 or more years of experience as a TRICARE Customer Service Representative or a Claims Processor.

Remote Work Requirements

  • Wired (ethernet cable) internet connection from your router to your computer
  • High speed cable or fiber internet
  • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
  • Please review Remote Worker FAQs for additional information

Benefits

  • Remote work options available
  • Performance bonus and/or merit increase opportunities
  • 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
  • Competitive paid time off
  • Health insurance, dental insurance, and telehealth services start DAY 1
  •  Employee Resource Groups
  • Professional and Leadership Development Programs
  •  Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace:  WPS Newsroom - Awards and Recognition.

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This position supports services under U.S. Department of Defense (DoD) Defense Health Agency (DHA) contract(s).  As such, the role is subject to all applicable federal regulations, DoD contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity.  DoD contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.

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