WPS—A health solutions company · 12 hours ago
Medicare Claims Representative
Minnesota, United States
Full-time
Hybrid
Entry Level
$18.50/hr - $18.50/hr
1+ years expWPS is a leading not-for-profit health solutions company headquartered in Madison, Wisconsin, that provides health insurance plans and manages benefits for military personnel and Medicare beneficiaries. The Medicare Claims Representative processes Medicare claims from receipt through resolution, ensuring timely and accurate resolutions while maintaining high standards for quality and customer service.
GovernmentHealth CareHealth Insurance
Responsibilities
Can review Medicare Part A claims, this includes complex and specialty claims, and by applying federal and internal guidelines to ensure appropriate application of processing guidelines, payment rules, and manual calculation procedures
Would enjoy handling complex adjustments involving multiple admissions and adjustments regarding pending returned notices and manually adjust reconsideration, including patient complaints and denials, and process through the system accordingly
Can communicate with internal departments, healthcare providers, and members to obtain additional information or clarify claim issues
Could interact with providers by phone to resolve pending claim problems, correspond with providers, other contractors, and third party billing support entity (s) on various claim-related problems
Would like to assist the claims department in meeting CMS performance metrics and minimum quality and quantity standards
Would enjoy supporting the claims department and provide back-up for completing staff responsibilities as needed
Can keep up to date with changes in regulations, coding standards, and plan policies
Can meet requirements of Federal Privacy Act, International Organization of Standards (ISO 9000), Freedom of Information, Desk Disclosure Reference, and WPS conflict of interest and confidentiality
Qualification
Required
High School Diploma or GED or equivalent experience
1 or more years of experience in hospital, clinic and/or medical office billing
1 or more years of post-high school education or coursework in insurance or medical-related studies
1 or more years of experience in a position using computer, keyboarding, and customer communications
Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy
Ability to multitask, prioritize, problem-solve, and effectively adapt to a fast-paced environment
Ability to work independently and meet quality and production standards
Preferred
Previous health/Medicare adjudication experience
Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims
Familiarity with medical terminology, procedure and diagnosis codes
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
Company
WPS—A health solutions company
WPS, a health solutions company, is an independent, not-for-profit, local company based in Madison, Wisconsin.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
HealthX Ventures
2025-10-20Series Unknown
Leadership Team
Frank Gumina
Chief Legal and Administrative Officer
Rochelle Myers
Chief Growth Officer and Head of New Ventures
Recent News
2025-11-22
2025-08-04
Company data provided by crunchbase