Health Insurance Claims Analyst - Remote

at WPS Health Solutions in Marion, Illinois, United States

Job Description

Health Insurance Claims Analyst - Remote
Who We Are
is a leading not-for-profit health insurer and federal government contractor headquartered in 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 Health Solutions has been making health care easier for the people we serve for more than . 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 inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse 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.
From 2021 to 2023, WPS Health Solutions was recognized for several awards:



Role Snapshot
Our Health Insurance Claims Analyst will work within our WPS HI Claims Department to help ensure both internal and external customer experience and satisfaction as claims are being processed. You will also be responsible for processing claims timely, accurately, and consistently. You will process and/or reprocess health insurance claims for payment or rejection through effective use of on-line systems maintaining high levels of observance to procedures, guidelines, and quality standards. This will include answering inquiries via phone or in writing regarding eligibility benefit determination and claim adjudication questions or problems. This role is a front-line position and will be able to establish and maintain rapport with contacts and present a favorable corporate image while responding to inquiries within timeframes required.
How do I know this opportunity is right for me? If you:
Would like working in team oriented environment with the ability to help update/create workflows and recommend process improvements.
Want to process complex claims requiring manual calculation of payments, including all coordination of benefits (COB) edits and calculations and special investigations (SIU) to determine abusive billing practices.
Can work assigned pended claims, including high dollar claims, timely and accurately in accordance with health plan benefits and established guidelines.
Have the ability to reprocess claims on basis of additional information received, including corrected claims submissions, make payment and non-cash adjustments to claims file as necessary.
Want to learn how to verify system applied benefit maximums, adjust deductibles and coinsurance, and verify contract limitations applied by systems.
Can identify and request information necessary to process benefits through interaction with providers, subscribers, groups, agents, and/or WPS personnel.
Have experience entering claims into claims processing system.
Like to solve problems, Identify and request information necessary to process benefits.
Can inform supervisor of system problems when identified, researching problems to provide backup data and examples when needed.
Like researching and respond to inquiries, which may include inquiries referred to executive or management staff, concerning problems in complex claims eligibility, claims filing and adjudication, and billing questions.
like to help people in a wide variety of situations to convey a favorable corporate image.
Possess excellent oral/written communication, analytical, problem-solving, mathematical, organizational, and interpersonal skillsets.
Have strong experience with Microsoft Office (Word, Excel), internet, and standard office equipment.
What will I gain from this role?
The ability to influence or motivate individuals in highly sensitive situations.
Ability to impact the customer experience.
Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiaries.
Working in a continuous performance feedback
Minimum Qualifications
High school diploma or equivalent
Preferred Qualifications
Experience in a WPS HI Claims Processing role.
Proven experience leading high performing teams
Strong experience using MS Excel
Proficient data entry and 10-key skills Two or more years of experience processing medical claims OR
Two or more years of office experience in a customer service insurance... For full info follow application link.

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

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Job Posting: 11696123

Posted On: Feb 22, 2024

Updated On: Mar 02, 2024

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