Top 50 Claims representative Jobs in Waukesha Wi

Account Resolution Representative
Children's Wisconsin —West Allis, WI
- Full-time
- Remote
- Anatomy knowledge
- HIPAA
- Research
- Flexible schedule
Workers Compensation Claims Representative
Wisconsin Municipal Mutual Insurance Company —Wisconsin
- Full-time
- Hybrid work
- Customer service
- Mid-level
- Residential
- Health savings account
- Health insurance
Quick Apply
Investment Client Srvcs Analyst (New Accounts) - Hybrid
Northwestern Mutual —Franklin, WI
- $23.11 - $34.66 an hour
- Full-time
- Computer literacy
- Writing skills
- Research
- Flexible schedule
12d
Investment Client Srvcs Analyst (Asset Movement) - Hybrid
Northwestern Mutual —Franklin, WI
- $23.11 - $34.66 an hour
- Full-time
- Writing skills
- Research
- Mid-level
- Flexible schedule
10d
Director of Revenue Cycle
Outreach Community Health Centers —Milwaukee, WI
- Management
- Writing skills
- Bachelor's degree
- Dental insurance
- Employee discount
Quick Apply
Account Representative II, HMO - Clinical Practice Services
The Medical College of Wisconsin, Inc. —Milwaukee, WI
- Full-time
- Hybrid work
- Mid-level
- High school diploma or GED
- Quality control
- Paid parental leave
- Paid holidays
Quick Apply
9d
Account Rep II, Medicare - Clinical Practice Services
The Medical College of Wisconsin, Inc. —Wauwatosa, WI
- Full-time
- Hybrid work
- Mid-level
- High school diploma or GED
- Quality control
- Paid parental leave
- Paid holidays
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Maggie Bringa - State Farm Agent —Waukesha, WI
- $40,000 - $60,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Pat Financial Svc Rep I
Children's Wisconsin —West Allis, WI
- Full-time
- High school diploma or GED
- Children
- Computer skills
Field Claim Representative
Germantown Mutual Insurance Company —Germantown, WI
- Full-time
- Hybrid work
- Customer service
- Mid-level
- 3 years
- Profit sharing
- Paid holidays
Quick Apply
4d
Customer Service Representative - State Farm Agent Team Member
Andy Lesar - State Farm Agent —Hales Corners, WI
- $50,000 - $60,000 a year
- Full-time
- Sales
- Office
- Communication skills
- Paid holidays
- Health insurance
Quick Apply
Account Resolution Representative Senior
Children's Wisconsin —West Allis, WI
- Full-time
- Bilingual
- Research
- Mid-level
Customer Service Representative - State Farm Agent Team Member
Paul Conradson - State Farm Agent —New Berlin, WI
- $45,000 - $70,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- 401(k) matching
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Brian Bartz - State Farm Agent —Wales, WI
- $35,000 - $50,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- 401(k)
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Adam Chamorro - State Farm Agent —Germantown, WI
- $50,000 - $60,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid holidays
- Disability insurance
Quick Apply
12d
Medical Billing Specialist
West Grove Clinic —Milwaukee, WI
- $22 - $25 an hour
- Full-time
- Customer service
- Basic math
- HIPAA
- Paid holidays
- Health insurance
Quick Apply
Customer Service Coordinator- New PAP
Advocate Aurora Health —West Allis, WI
- $22.90 - $34.35 an hour
- Full-time
- Ability to walk for extended periods
- 5 years
- Writing skills
22h
Customer Service Representative - State Farm Agent Team Member
Jason Marquardt - State Farm Agent —Menomonee Falls, WI
- $45,000 - $50,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Intake Specialist
Wellpoint Care Network —Milwaukee, WI
- Online Application
- Vital signs
- Microsoft Outlook
- Medical office experience
Quick Apply
Customer Service Representative
Allstate Insurance Agency - David Kelley —Milwaukee, WI
- $55,000 - $80,000 a year
- Full-time
- Computer literacy
- Office
- High school diploma or GED
- Paid training
- 401(k)
Quick Apply

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Account Resolution Representative

Children's Wisconsin -
West Allis, WI

Apply Now

Job Details

Full-time

Benefits

Flexible schedule

Qualifications

High school diploma or GED
Medical explanation of benefits reviews

Full Job Description

At Children’s Wisconsin, we believe kids deserve the best.

Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/

Job Summary
The Account Resolution Representative is responsible for obtaining fiscal resolution of Government, Medicaid HMO, and Commercial insurance claims. Fiscal resolution is accomplished through following governmental regulations and guidelines & commercial insurance contractual agreements to ensure facility is receiving proper payment for services rendered. The Account Resolution Representative is responsible for investigation of claims denials, insurance processing errors, & open no response claims; in addition to verification accounts are with the correct payer liability and balance. The role also requires follow up on previously actioned on denials, escalation of stalled claims, and identification of payer specific trends to escalate with the Hospital Billing leadership team.

Essential Functions

Utilizes Hospital computer billing system(s) (Epic) to follow-up on unpaid, underpaid, and credit balance claims ensuring timely filing guidelines are followed.
Verifies accounts are with the correct payer liability and balance with the payer by utilizing payer websites and electronic eligibility clearinghouses to verify the accuracy of the patient insurance information. Ensures timely claim submission(s).
Performs comprehensive collection actions including contacting patients/parents, insurance companies, correcting and resubmitting claims. Documents activities in the appropriate system.
Responsible for responding to and resolving claim denials by filing appeals in accordance with individual payer requirements.
Identifies and escalates denials to RN Auditors per applicable departmental policies and procedures.
Analyzes payer errors and/or denials to identify trends. Escalates trends and high volume issues to Lead and Management to lessen impact on Cash flow.
Validates and facilitates release of information (ROI) requests for patient medical records from external requestors (insurance payers and third-party vendors) in a timely and efficient manner. Partners with Release of Information team and vendor to ensure deadlines related to release of information are met to avoid denials and financial risks to Children’s Wisconsin. Ensures accuracy and quality of the medical records processed and released.
Investigates credit balances to include research of EOB’s and verification of accurate contractual discounts. Review written requests for refunds from insurance companies and other payers to protect CHW’s financial interests and completes appropriate paperwork for management authorization.
Maintains current knowledge of all payer contracts and third party payer billing/ reimbursement policies for all lines of business (Government, HMO and Commercial).
Reviews and enters adjustment requests as appropriate using departmental specific adjustment codes.

Legacy Essential Functions

Works with Lead to resolve complex claims issues using all available departmental resources.
Complies with productivity standards while maintaining quality levels. Documents all work in accordance with departmental standards.
Responsible for understanding and adhering to the Children’s Organizational Code of Ethics and for ensuring that personal actions comply with the policies, regulations and laws applicable to Children's business.
Utilizes appropriate tools and resources to assist in the processing and follow up of claims, such as Adobe, RightFax and payer and vendor websites.

Education:

High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) Required
Associate's Degree or higher in Medical Billing and Coding, in Health information Management, Healthcare Services Management, Health Information Technology Preferred or
Associate's Degree in a business related field Preferred

Experience:

2+ years experience in claims follow up , HCFAs and/or UB-04’s (preferably in a hospital setting) including insurance reimbursement procedures and comprehension of insurance EOB’s Required
General pediatric and/or pediatric subspecialty experience Preferred
Prior Epic experience Preferred

Knowledge, Skills and Abilities:

Basic knowledge of medical records and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Basic knowledge and understanding of medical terminology and human anatomy and disease processes.
Basic knowledge of ICD-10, CPT and HCPCS level II codes.
Demonstrates accuracy and attention to detail.
Demonstrated strong problem solving skills including the ability to handle difficult situations.
Ability to prioritize, organize and meet deadlines.
Excellent verbal and written communication skills.
Ability to work independently with minimal supervision.
Comfortable in both making decisions and acting.
Ability to multi-task and function effectively in a team environment and maintain effective relationships with coworkers, vendors and payers.
Advanced computer skills including in using Microsoft Office products, Adobe, electronic mail and/or electronic health information records systems and proficient keyboarding skills.

Required for All Jobs:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job.
Employment is at-will. This document does not create an employment contract, implied or otherwise.

Remote Position!
Flexible schedule
Epic preferred
2+ years in claims follow‑up with HCFAs/UB‑04s and insurance reimbursement/EOB comprehension required
Pediatric or pediatric subspecialty experience preferred
Prior Epic experience preferred

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses:

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Refine Your Search

claims representative jobs in waukesha wi

Account Resolution Representative

Workers Compensation Claims Representative

Investment Client Srvcs Analyst (New Accounts) - Hybrid

Investment Client Srvcs Analyst (Asset Movement) - Hybrid

Director of Revenue Cycle

Account Representative II, HMO - Clinical Practice Services

Account Rep II, Medicare - Clinical Practice Services

Customer Service Representative - State Farm Agent Team Member

Pat Financial Svc Rep I

Field Claim Representative

Customer Service Representative - State Farm Agent Team Member

Account Resolution Representative Senior

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - State Farm Agent Team Member

Medical Billing Specialist

Customer Service Coordinator- New PAP

Customer Service Representative - State Farm Agent Team Member

Intake Specialist

Customer Service Representative

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