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Remote Medical Claims Processor Jobs in Sun Prairie, WI

Talkiatry

Psychiatrist (Remote)

Madison, WI · Remote

$325K - $375K/yr

Active, unrestricted medical license (multi-state licensing support available) * Interest in ... If you need a reasonable accommodation to complete the application or interview process, please ...

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Remote Medical Claims Processor information

See Sun Prairie, WI salary details

$13

$18

$25

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

As of Aug 16, 2026, the average hourly pay for remote medical claims processor in Sun Prairie, WI is $18.94, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $21.06 per hour, depending on experience, location, and employer.

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.

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 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 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.
More about Remote Medical Claims Processor jobs

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

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

Remote Medical Claims Processor jobs near you

Senior Account Manager - Health Insurance

WPS Health Solutions

Madison, WI • On-site, Remote

$85K - $105K/yr

Full-time

Medical, Dental, Life, Retirement, PTO

Posted 23 days ago

WPS Health Solutions rating

8.3

Company rating: 8.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

128th of 308 rated insurance

Job description

Role Snapshot
Our Senior Account Manager manages a book of mid-market and large employer groups (typically 250 – 1,000 lives), providing strategic guidance on benefit planning, renewal strategy, cost management, and member engagement. The Sr Account Manager will partner with the sales team to implement new employer groups and serve as the primary point of contact for ongoing support. They are accountable for developing and maintaining relationships with assigned employer group clients and identifying ways to drive growth and retention within our Health Plan.

Salary Range
$85,000 ~ $105,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
Remote work
Wisconsin - this position will have travel in the State of Wisconsin.
*As a secondary consideration, we could offer remote work in the following approved states:
Illinois, Iowa, Michigan, Minnesota.

How do I know this opportunity is right for me?  If you:

  • Enjoy building and maintaining relationships with employer group leaders and broker partners to ensure retention year-to-year for assigned employer groups.
  • Have consulted with employer group accounts on plan benefits, performance data, and trends to identify opportunities for improvement, growth, and cross-selling.
  • Can lead complex renewals and present plan design recommendations.
  • Want to serve as a trusted advisor to employer group leaders and benefit decision-makers.
  • Would like to coordinate multi-product offerings (medical, dental, stop-loss, etc.) in support of a comprehensive benefit strategy.
  • Thrive when Partnering with Account Executives and underwriting on pricing strategies and negotiate renewals with employer group leaders and brokers.
  • Can proactively engage with clients through regular check-ins and provide benefit education to group leaders and members.
  • Want to serve as primary contact for client inquiries and service needs and ensure effective and timely resolution.
  • Can contribute to mentorship and knowledge-sharing across the sales and account management teams.
  • Would enjoy representing WPS at benefit fairs, board-level presentations, and broker strategy sessions.
  • Can maintain accurate CRM records and support sales growth opportunities.

Minimum Qualifications

  • Bachelor’s degree in Business, Marketing, Healthcare Administration or related field or equivalent combination of education/experience.
  • Valid Wisconsin Accident & Health producer license.
  • 5 or more years of progressive responsibility as an Account Manager or related experience.
  • Strong knowledge and understanding of health insurance benefit design.
  • Demonstrated experience in Health and Life Insurance Administration.
  • Excellent organizational, interpersonal, verbal and written communication skills this includes:
    • Strong problem-solving and workload prioritization skills.
    • Strong public speaking and presentation skills which include comfort in the presence of large audiences.
  • Ability to travel within the state of Wisconsin – up to 50%.
  • Valid driver’s license with no moving violations or accidents in the last three years.

Preferred

  • Self-Funded experience.
  • Experience using CRMs (i.e.: MS Dynamics, Salesforce).

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 and hybrid 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
  • 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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