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Remote Medical Claims Processor Jobs in Shiocton, WI

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

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 ...

Thedacare

Accounts Receivable Specialist - Remote

Neenah, WI · On-site +1

$20.50 - $27/hr

... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist ... Reviews, analyzes, and processes billed claims for accuracy upon submission, including charges ...

ThedaCare

Accounts Receivable Specialist - Remote

Appleton, WI · On-site +1

$19.75 - $26/hr

... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist ... Reviews, analyzes, and processes billed claims for accuracy upon submission, including charges ...

ThedaCare

Accounts Receivable Specialist - Remote

Appleton, WI · On-site +1

$19.75 - $26/hr

... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist ... Reviews, analyzes, and processes billed claims for accuracy upon submission, including charges ...

ThedaCare

Accounts Receivable Specialist - Remote

Neenah, WI · On-site +1

$20.50 - $27/hr

... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist ... Reviews, analyzes, and processes billed claims for accuracy upon submission, including charges ...

ThedaCare

Accounts Receivable Specialist - Remote

Neenah, WI · On-site +1

$20.50 - $27/hr

... medical staff, to resolve claim issues and manage accounts receivable efficiently. The specialist ... Reviews, analyzes, and processes billed claims for accuracy upon submission, including charges ...

micro1 AI

Medical Writing Manager

Green Bay, WI · Remote

$50 - $80/hr

Remote micro1 is engaging Medical Writers / Clinical Document Authors to participate in a customer ... Trace narrative claims to source records--tables, figures, listings, and protocols--to verify that ...

micro1 AI

Medical Billing Specialist

Green Bay, WI · Remote

$50 - $80/hr

Remote micro1 is engaging Medical Writers / Clinical Document Authors to participate in a customer ... Trace narrative claims to source records--tables, figures, listings, and protocols--to verify that ...

Network Health

Associate Medical Director

Menasha, WI · On-site +1

... processes * Provide medical consultation as requested for: * Medical/legal issues * Member ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines

Hshs

Dosimetrist - Remote

Green Bay, WI · Remote

$50.54 - $75.81/hr

Bachelor's Degree in Medical Dosimetry or Physics or two years experience as a Dosimetrist is ... Notice Regarding Potential Use of Artificial Intelligence in the Hiring Process Hospital Sisters ...

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All JobsMedical Claims Processor JobsRemote Medical Claims Processor JobsRemote Medical Claims Processor Jobs in Shiocton, WI

Remote Medical Claims Processor information

See Shiocton, WI salary details

$12

$17

$22

How much do remote medical claims processor jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for remote medical claims processor in Shiocton, WI is $17.09, according to ZipRecruiter salary data. Most workers in this role earn between $15.19 and $18.99 per hour, depending on experience, location, and employer.

What is a remote medical claims processor?

Remote medical claims processors handle billing paperwork for health care offices or insurance companies. Instead of working in the office, remote medical claims processors complete their job duties from home or another location outside of the office with internet connectivity. As a remote medical claims processor, your responsibilities include ensuring medical insurance claims have proper billing codes that match the services provided, clarifying patient concerns about benefits, and adding changes made to the claim by the doctors or insurer. You may also be required to follow up with the insurer to find out the status of claims and discuss any discrepancies.

What does a remote medical claims processor do?

A Remote Medical Claims Processor reviews, evaluates, and processes insurance claims submitted by healthcare providers and patients. Working from a remote location, they verify the accuracy of claim information, ensure proper coding, and determine whether services are covered based on insurance policies. They also communicate with providers, patients, and insurance companies to resolve discrepancies or request additional information. This role helps ensure that claims are processed efficiently and accurately for timely reimbursement.

What are the key skills and qualifications needed to thrive as a remote medical claims processor?

To thrive as a Remote Medical Claims Processor, a solid understanding of medical terminology, insurance policies, and claims adjudication is essential, typically supported by a high school diploma or equivalent and relevant experience. Familiarity with claims management software, electronic health records (EHR) systems, and knowledge of HIPAA regulations are typically required. Attention to detail, strong organizational skills, and clear written communication help individuals excel in processing claims accurately and efficiently. These skills ensure timely and correct claims processing, reducing errors and supporting the financial health of both healthcare providers and patients.

How does a remote medical claims processor typically collaborate with healthcare providers and insurance companies while working from home?

As a Remote Medical Claims Processor, collaboration with healthcare providers and insurance companies primarily occurs through secure digital communication channels, such as email, specialized claims management software, and phone calls. You will regularly interact with provider offices to clarify patient information, verify coverage, or resolve discrepancies in submitted claims. While the role is independent, you often coordinate with team members and supervisors virtually to ensure claims are processed efficiently and accurately. Maintaining clear documentation and communication is essential for resolving issues and minimizing processing delays.

What is the difference between Remote Medical Claims Processor vs Remote Medical Billing Specialist?

AspectRemote Medical Claims ProcessorRemote Medical Billing Specialist
CredentialsTypically requires medical coding or claims processing certificationsOften requires medical billing certifications and coding knowledge
Work EnvironmentRemote, healthcare or insurance companiesRemote, healthcare providers or billing companies
Industry UsageInsurance companies, third-party administratorsHospitals, clinics, billing service providers
Job FocusProcessing and reviewing insurance claims for reimbursementPreparing and submitting bills, managing accounts receivable

While both roles work remotely within the healthcare industry, the Remote Medical Claims Processor primarily reviews and processes insurance claims, focusing on reimbursement. In contrast, the Remote Medical Billing Specialist handles billing procedures, including preparing and submitting invoices. Both roles require similar certifications and often overlap in work environment and employer types, but their core responsibilities differ in claim review versus billing management.

More about Remote Medical Claims Processor jobs

What cities near Shiocton, WI are hiring for Remote Medical Claims Processor jobs?

Cities near Shiocton, WI with the most Remote Medical Claims Processor job openings:

Remote Medical Claims Processor jobs near you
Infographic showing various Remote Medical Claims Processor job openings in Shiocton, WI as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 15% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $35,555 per year, or $17.1 per hour.

Claims Analyst II

Network Health, Inc

Menasha, WI • On-site, Remote

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.

    Apply