Medicare Claims Specialist

Role Overview
As a Medicare Claims Specialist, you will expertly handle the processing of Medicare claims from initiation to resolution, complying with all relevant policies, procedures, and regulations. Your goal will be to ensure that claims are resolved quickly and accurately while maintaining outstanding quality and customer service standards.

Compensation

• Hourly Rate: $18.50/hour or more, based on applicable county SCA rates.
• Start Date: 2/24/26
• Training Schedule: Mandatory phased training from Monday to Friday over the first 8 months. Initial 4-week training sessions will take place Monday-Friday from 7:30 AM - 4:00 PM, with subsequent 3-week training sessions to follow on similarly scheduled days.
• Work Shift: Flexible 8-hour shifts available between 6:00 AM - 6:00 PM CST after training is complete; split shifts are an option.

Remote Work Availability
We welcome remote work options in several approved states including Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, and Wisconsin.

Is This Role Right for You?
If you:

• Can review Medicare Part A claims, including complex and specialty cases, applying internal and federal guidelines effectively.
• Enjoy tackling complex adjustments related to multiple admissions, processing reconsiderations, patient complaints, and denials.
• Communicate effectively with various departments, healthcare providers, and members to clarify claim issues.
• Are comfortable interacting with providers via phone to resolve claim issues and corresponding on related problems.
• Are motivated to help the claims department meet CMS performance metrics.
• Enjoy supporting team members and covering other staff responsibilities as needed.
• Keep updated on changes to regulations, coding standards, and plan policies.
• Understand the importance of compliance with the Federal Privacy Act and other regulatory frameworks.

What You'll Gain in This Role

• A flexible work schedule.
• Learning opportunities through sharing knowledge with experienced teammates and trainers.
• Skills development with numerous growth opportunities within the organization.
• Experience supporting military personnel, veterans, and Medicare beneficiaries.
• A culture of continuous feedback and improvement.

Minimum Qualifications

• High School Diploma or GED or equivalent experience.
• 1+ years of experience in hospital, clinic, or medical office billing.
• 1+ years of relevant coursework in insurance or medical disciplines.
• 1+ years of experience in a computer-based role with customer interaction.
• Proven data entry skills with strong focus and attention to detail.
• Able to multitask and adapt to a fast-paced environment.
• Self-motivated and committed to quality and production standards.

Preferred Qualifications

• Prior experience in health or Medicare claims adjudication.
• Familiarity with UB (CMS-1450) and HCFA (CMS-1500) claims.
• Understanding of medical terminology, procedure, and diagnosis codes.

Remote Work Requirements

• Reliable wired internet connection from your router to your computer.
• High-speed cable or fiber internet with a minimum of 10 Mbps downstream and 1 Mbps upstream.

Benefits

• Options for remote and hybrid work.
• Performance bonuses and merit increase opportunities.
• 401(k) with matching contributions.
• Generous paid time off policy.
• Health, dental, and telehealth services start on DAY 1.
• Professional development opportunities.

About Us
WPS is a leading not-for-profit health insurer and federal contractor based in Madison, Wisconsin, dedicated to providing health insurance plans for individuals, families, and military personnel. With nearly 80 years of experience, we strive to simplify healthcare for our members.

Our Culture
At WPS, we cultivate an empowering environment that fosters innovation and inclusivity among our employees. Our recognition as a great workplace reflects our commitment to engagement and diverse perspectives.

WPS is an Equal Opportunity Employer that values diversity and inclusion.