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Healthcare Claims and Benefits Design Engineer

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Job Details
Job Order Number
Company Name
WPS Health Solutions
Physical Address
Company Worksite
Chicago, IL 60629
Job Description

Role Summary:

Claims Technical and Development Specialist will review and interpret data within complex claims systems to determine accuracy and compliance with contractual obligations. Collaborate with cross functional groups to develop and implement system updates, ensure continued improvement in the synchronization of systems, people, and processes. Participate in management reviews that include presenting and communicating analysis results to partners and customers, summarizing conclusions, and recommending a course of action. Act as a mentor to current Military Veteran Health (MVH) Process Analysts to enhance their knowledge of industry practices.

This person must have knowledge of, and keep current on, industry requirements related to processing health insurance claims. This includes but is not limited to CMS reimbursement requirements, Health Insurance Portability and Accountability Act electronic transactions for exchanging health care data, ICD-10 coding requirements and healthcare policies.

In this role you will:

  • Analyze and interpret claims data ensuring claims processing system is designed to accurately adjudicate claims consistent with healthcare coverage, reimbursement methodologies, and contractual requirements
  • Actively collaborate with management and staff to ensure that industry best practices are followed
  • Continually strategize and plan new efficiencies and innovative process improvements
  • Optimize use of resources and enhance operations through new and updated technologies
  • Identify, prioritize and facilitate claims improvement projects
  • Facilitate workgroups to identify ways to increase quality and efficiency and operational processes
  • Assist in the exploration, evaluation and design of in-house or purchased technology solutions for current and future business needs

This role could be a good fit if you:

  • Have experience working in health insurance claims environments
  • Possess a strong technical affinity, and curiosity with the ability explain highly complex technical claims processing and systems
  • Are driven to innovate and want to see the real time effects actualized

You’ll benefit from this experience by:

  • Being able to provide strategy and guidance in the innovation WPS’s claims systems
  • Working as a leader in a results oriented change environment
  • Working in an environment that serves our Nation’s military, veterans, Guard and Reserves along with their families

You need to have:

  • Bachelor’s degree or equivalent work experience
  • 10 or more years of progressive experience in a healthcare claims processing environment that includes evaluating claims issues and trends to modify processes, workflows, and strategies

We also prefer:

  • Outstanding written and verbal communication skills
  • Strong understanding of CMS requirements and claims regulations

Your team:

  • Information about the team that this individual will be working with
  • This can be individuals on the team or information about the business lines

Compensation and Benefits

  • Eligible for annual Performance Bonus Program
  • 401(k) with dollar-per-dollar match up to 6% of salary
  • Competitive paid time off
  • Health and dental insurance start DAY 1
  • Vision insurance
  • Flexible spending, dependent care, and health savings accounts
  • Short- and long-term disability, group life insurance
  • Innovative professional and cognitive development programs

Who We Are

WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.

Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government’s Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.

WPS has been named one of the by the Ethisphere® Institute for 10 years in a row.


Our Purpose and Values

Our purpose is to make healthcare easier for those we serve.

Our values – Customer Focused, Individual Responsibility, Mutual Respect, and Driven & Passionate – are the core of who we are and how we conduct business every day.

Military and Veterans HealthWPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.

Health InsuranceWPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.

Government Health Administrators WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare & Medicare Services, we’ve served Medicare beneficiaries and their health care providers since 1966.


Arise Health Plan provides innovative and high-value health plans to groups and individuals in eastern and northeastern Wisconsin. With our quality Wisconsin-based customer service, Arise offers health care expertise with a personal touch.

EPIC Specialty Benefits

EPIC Specialty Benefits provides businesses group insurance products that cover:

  • Life
  • Disability
  • Dental
  • Vision
  • Voluntary benefits

Stay connected:


Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or © consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35©

Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.

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