Health Insurance Claims Analyst – Remote

Job Details

Description

Health Insurance Claims Analyst – Remote

Who We Are

WPS Health Solutions 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 75 years. 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:

• Madison, Wisconsin’s Top Workplaces
• USA Top Workplaces and the cultural excellence awards for Remote Work and Work-Life Flexibility
• Achievers 50 Most Engaged Workplaces® with the further honor of Achievers “Elite 8” winner in the category of Culture Alignment
• DAV Patriot Employer
• VETS Indexes 4 Star Employer
• BBB Torch Award for Ethics from Better Business Bureau of Wisconsin

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 environment
• Ability to learn medical and insurance terminology.
• Ability to learn Claims regulations, benefits, procedures, and on-line systems.
• Ability to learn provider coding, entry, and Other Health Insurance (OHI).
• Knowledge and ability to learn Current Procedural Terminology (CPT), and International.
• Statistical Classification of Disease and Related Health Problems (ICD-10) codes

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

Hourly Rate of Pay

• $17.50/hour ~ $20.25/hour

Start Date: 5/6/24

Scheduled Shift: Flexible schedule once trained, 8-hours shifts between 6:00am-6:00pm Central. Shift ending at 4:30pm Central once a week for phone coverage.

Work Location

We are a remote-first organization and offer remote work in the following approved states:

Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin 

To help strengthen communication, provide a sense of community, and improve the overall remote work experience, the assigned office community based on the position’s division is: Health Insurance Division – Waukesha, Wisconsin,

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits here

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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 (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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