Claims Processing Specialist

Health Payment Systems Inc•Milwaukee, WI

1d•$22 - $24•Hybrid

About The Position

The Claims Processing Specialist supports the Claims Processing team by ensuring accurate, timely, and efficient handling of medical claims received from Third-Party Administrators (TPAs). This role is critical to daily business operations because claims must be processed consistently and accurately to ensure payments flow without disruption. The ideal candidate is highly detail-oriented, thrives in a fast-paced environment, and can navigate ambiguity while solving problems independently. You will be expected to analyze claims, identify discrepancies, and take action to resolve issues before processing. This role reports directly to our Claims Processing Supervisor and follows a hybrid work schedule (2–3 days onsite, subject to business needs).

Requirements

3+ years of experience in medical claims processing with strong knowledge of CPT, HCPCS, ICD-10, and claims adjudication processes.
Experience working with TPA systems, claims platforms, or healthcare insurance-related tools.
Proficiency in Microsoft Excel, Word, and Outlook.

Responsibilities

Process medical claims across an internal system (PPS).
Identify and resolve discrepancies prior to adjudication to prevent downstream issues.
Respond to employer group and TPA inquiries with timely, professional communication.
Investigate and resolve escalated claims issues, including adjustments and customer concerns.
Prepare and distribute reports and employer credit documentation.
Navigate internal systems and tools (including Zendesk) to manage workflows efficiently.
Partner cross-functionally with Customer Care, Finance, and IT to address complex issues.
Contribute to ad hoc reporting, operational improvements, and special projects.
Maintain accuracy and productivity standards in a high-volume environment.