Medicare Claims Specialist II - Remote

WPS—A health solutions company; Iowa; Remote; USD 22,000 - 31,000; Full time

Benefits offered by this job

Remote work options available

Performance bonus and merit increase

401(k) with match

Health insurance from DAY 1

Dental insurance and telehealth

Professional development programs

Careers page reviewed

Job summary

WPS, a health solutions company, is seeking a Claims Rep 2 to process Medicare claims from receipt to resolution, ensuring timely and accurate outcomes with strong customer service.

The role supports remote work in select states; on-the-job training will occur Monday–Friday 7:30am–4:00pm CT, with 8-hour shifts once trained. This position requires attention to detail and regulatory compliance.

Qualifications

• High School Diploma or GED or equivalent experience.
• 1+ years of hospital/clinic/medical office billing experience.
• 1+ years of post-high school education or coursework in insurance or medical-related studies.
• Demonstrated proficiency in data entry with accuracy.
• Ability to multitask, prioritize, problem-solve, and adapt to a fast-paced environment.
• Ability to work independently and meet quality and production standards.

Responsibilities

• Review Medicare Part A and Part B claims, applying federal and internal guidelines for processing and payment rules.
• Handle complex adjustments involving admissions and pending notices; process reconsiderations and denials.
• Communicate with internal departments, providers, and members to obtain information and clarify issues.
• Speak with providers by phone to resolve claim problems; correspond with contractors and QIOs on claim issues.
• Assist department in meeting CMS performance metrics and quality standards.
• Provide back-up to staff duties and stay updated on regulations, coding standards, and plan policies.

Skills

Data entry

Multitasking

Prioritization

Problem solving

Adaptability

Independent work

Education

High School Diploma or GED

Post-high school education or coursework in insurance/medical-related studies

Job description

WPS, a health solutions company, is seeking a Claims Rep 2 to process Medicare claims from receipt to resolution, ensuring timely and accurate outcomes with strong customer service.

The role supports remote work in select states; on-the-job training will occur Monday–Friday 7:30am–4:00pm CT, with 8-hour shifts once trained. This position requires attention to detail and regulatory compliance.