Medicare Claims Specialist II — Remote, Flexible Hours

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

Benefits offered by this job

Remote work options

Performance bonus

401(k) with company match

Health insurance and telehealth

Job summary

WPS Health Solutions is seeking a Claims Representative 2 to process Medicare claims from receipt to resolution in a compliant, timely manner. The role supports remote work in multiple states and offers an hourly pay rate with initial training and flexible later shifts.

The position requires knowledge of Medicare guidelines, strong data entry, and the ability to multi-task in a fast-paced environment while maintaining quality and compliance with CMS and ISO standards.

Qualifications

• High School Diploma or GED or equivalent experience.
• 1+ year experience in hospital/clinic/medical billing.
• 1+ year post-high school education in insurance or medical studies.
• Strong data-entry accuracy and concentration.
• Ability to multitask and work in a fast-paced environment.
• Ability to work independently and meet quality standards.

Responsibilities

• Review Medicare Part A and Part B claims following federal and internal guidelines.
• Handle complex adjustments and reconsiderations including denials.
• Communicate with providers, departments, and members to clarify claim issues.
• Interact with providers by phone to resolve pending claim problems and follow up.
• Assist department in meeting CMS performance metrics and quality standards.
• Keep up to date with changes in regulations, coding standards, and plan policies.

Skills

Data entry

Multitasking

Attention to detail

Customer service

Problem solving

Education

High School Diploma or GED

1+ year post-secondary education in insurance/medical studies

Job description

WPS Health Solutions is seeking a Claims Representative 2 to process Medicare claims from receipt to resolution in a compliant, timely manner. The role supports remote work in multiple states and offers an hourly pay rate with initial training and flexible later shifts.

The position requires knowledge of Medicare guidelines, strong data entry, and the ability to multi-task in a fast-paced environment while maintaining quality and compliance with CMS and ISO standards.