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Remote Claims Processor Jobs in Sun Prairie, WI (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 ... We process claims and provide customer support for beneficiaries of the Medicare program and manage ...

WPS Health Solutions

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 ... We process claims and provide customer support for beneficiaries of the Medicare program and manage ...

Corvel

Indemnity Claims Specialist

Madison, WI · Remote

$51K - $83K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives claims, confirms ... process taking into consideration experience, qualifications, and overall fit for the role. The ...

WPS Health Solutions

Claims Examiner II

Madison, WI · On-site +1

$17.75/hr

Work Location : 100% remote opportunity. Please note that the assigned office for this position is ... We process claims and provide customer support for beneficiaries of the Medicare program and manage ...

CBCS

Workers Compensation Claims Adjuster

Madison, WI · On-site +1

$66K - $86K/yr

Workers Compensation Claims Adjuster Location: Work from Home Who says you can't have it all? Cottingham & Butler Claims Services (CBCS) is offering the opportunity to work in a fast-paced and ...

Auxiant

Account Manager - Remote

Madison, WI · On-site +1

Knowledge of self-funded or fully-insured health plans (HIPAA, DOL regulations, ERISA, medical terminology and claims processing preferred but not required). * PC skills including Microsoft Office ...

Auxiant

Account Manager - Remote

Madison, WI · On-site +1

Knowledge of self-funded or fully-insured health plans (HIPAA, DOL regulations, ERISA, medical terminology and claims processing preferred but not required). * PC skills including Microsoft Office ...

Auxiant

Account Manager - Remote

Madison, WI · On-site +1

Knowledge of self-funded or fully-insured health plans (HIPAA, DOL regulations, ERISA, medical terminology and claims processing preferred but not required). * PC skills including Microsoft Office ...

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All JobsClaims Processor JobsRemote Claims Processor JobsRemote Claims Processor Jobs in Sun Prairie, WI

Remote Claims Processor information

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How much do remote claims processor jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for remote claims processor in Sun Prairie, WI is $18.65, according to ZipRecruiter salary data. Most workers in this role earn between $15.91 and $20.10 per hour, depending on experience, location, and employer.

What are some common challenges faced by Remote Claims Processors, and how can they be addressed?

Remote Claims Processors often encounter challenges such as managing high volumes of claims, maintaining accuracy without in-person supervision, and communicating effectively with team members across different locations. To address these, it's essential to develop strong organizational skills, utilize digital tools for tracking and documentation, and participate actively in virtual team meetings. Proactively seeking feedback and staying updated on policy changes can also enhance efficiency and reduce errors in a remote setting.

What Does a Remote Claims Processor Do?

The job duties of a remote claims processor revolve around working to process insurance claims. You typically work from home or another remote location. Your responsibilities start with assessing the claimant's insurance policy and coverage. You review documents and records related to the claim and decide on approval or denial of the claim. A processor also prepares the paperwork necessary for the insurer to process the case for the client. You also have customer service duties, such as answering patient questions and telling them about the claim status. Processors can work with medical insurance, property insurance, or casualty insurance.

What does a Remote Claims Processor do?

A Remote Claims Processor reviews, evaluates, and processes insurance claims from a remote location, typically working from home. They verify information, assess documentation, and determine the validity of claims for insurance companies or healthcare providers. This role requires attention to detail, knowledge of insurance policies, and the ability to communicate with clients or providers to resolve discrepancies. Remote Claims Processors use specialized software to manage claims efficiently and ensure compliance with industry regulations.

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 strong attention to detail, analytical skills, and a solid understanding of insurance policies, often supported by a high school diploma or relevant experience. Familiarity with claims management software, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent written communication, time management, and problem-solving abilities help you stand out in this role. These skills ensure accurate and efficient claims handling, customer satisfaction, and compliance with regulatory standards in a remote work environment.

What is the difference between Remote Claims Processor vs Remote Claims Examiner?

AspectRemote Claims ProcessorRemote Claims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may require insurance or claims processing certificationsHigh school diploma or equivalent; often requires licensing or certification in insurance claims examination
Work EnvironmentHome-based or remote office; primarily computer and phone workHome-based or remote; involves reviewing and analyzing insurance claims
Industry UsageInsurance, healthcare, government agenciesInsurance companies, healthcare providers, government agencies
Common Search/ComparisonYesYes

Remote Claims Processors and Remote Claims Examiners both work in the insurance industry, often remotely, handling claims. While both roles require similar credentials and work environments, Claims Examiners typically perform more detailed analysis and may require specific licensing. Understanding these differences helps job seekers identify the right position based on their skills and certifications.

More about Remote Claims Processor jobs
What are popular job titles related to Remote Claims Processor jobs in Sun Prairie, WI? For Remote Claims Processor jobs in Sun Prairie, WI, the most frequently searched job titles are:
What cities near Sun Prairie, WI are hiring for Remote Claims Processor jobs? Cities near Sun Prairie, WI with the most Remote Claims Processor job openings:
Remote Claims Processor jobs near you
Infographic showing various Remote Claims Processor job openings in Sun Prairie, WI as of May 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $38,785 per year, or $18.6 per hour.
Appeals Claims Processor

Appeals Claims Processor

WPS

Madison, WI • On-site, Remote

$19.60/hr

Full-time

Medical, Dental, Retirement, PTO

Posted 5 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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LinkedInFacebookWPS Health BlogThis 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.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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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