Remote Medicare Claims Specialist

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

Benefits offered by this job

Remote work options available

Performance bonus/merit increases

401(k) with matching

Job summary

WPS, a health solutions company, seeks a Claims Rep 2 to process Medicare claims from receipt to resolution, ensuring timely, accurate handling per policies and regulations. Training begins with on-the-job sessions Monday–Friday, 7:30am–4:00pm CT, with flexible shifts after training.

The role emphasizes quality, customer service, and adherence to CMS guidelines, ISO standards, privacy acts, and confidentiality. Remote work is available in multiple states including Ohio.

Qualifications

• High School Diploma or GED or equivalent experience.
• 1+ year experience in hospital, clinic and/or medical office billing.
• 1+ year post-high school education or coursework in insurance or medical-related studies, with computer, keyboarding and customer communications experience.
• Demonstrated proficiency in data entry with strong focus and 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 with guidelines to ensure proper processing and payment rules.
• Handle complex adjustments including reconsideration and patient complaints/denials.
• Communicate with internal departments, providers, and members to obtain information or clarify issues.
• Interact with providers by phone to resolve claim problems; correspond with providers, contractors, and QIOs on issues.
• Assist department in meeting CMS performance metrics and quality standards.
• Support Claims department and back-up staff responsibilities as needed.
• Stay updated with changes in regulations, coding standards, and plan policies.

Skills

Data entry

Multitasking

Customer communication

Attention to detail

Education

High School Diploma or GED

Job description

WPS, a health solutions company, seeks a Claims Rep 2 to process Medicare claims from receipt to resolution, ensuring timely, accurate handling per policies and regulations. Training begins with on-the-job sessions Monday–Friday, 7:30am–4:00pm CT, with flexible shifts after training.

The role emphasizes quality, customer service, and adherence to CMS guidelines, ISO standards, privacy acts, and confidentiality. Remote work is available in multiple states including Ohio.