Wisconsin Claims Analyst II

Job Summary

To support efficient claims processing, the full-time salaried Wisconsin Claims Analyst II will examine and process paper and electronic claims, determining whether to return, pend, deny, or pay claims in accordance with established policies and procedures, with the flexibility to work remotely or onsite in Menasha or Brookfield.

Key responsibilities:

• Adjudicate claims following departmental policies and corporate guidelines
• Resolve claims and related issues while ensuring compliance with policy provisions
• Monitor and correct claims processing errors in the computerized system

Required qualifications:

• High school diploma or equivalent preferred
• 2-4 years of claims processing experience required
• Knowledge of current procedural terminology (CPT) and ICD-9/ICD-10
• Past experience using QNXT Claims Workflow is a plus
• Prior experience with ACA, Medicaid, or similar health plans preferred