Payment Records Adjuster (Claims Support Specialist)

U.S. Citizenship is required for this position due to Department of Defense restrictions.

Correct payment errors on a post-processing basis, including credits, additional payments, statistical adjustments, recoupments, correspondence, and patient or sponsor updates. Must live within 45 miles of WPS Corporate Center Building (1717 W. Broadway) in Madison, WI 53713

Additional Information

• Start Date: 8/23/26
• Starting Base Salary: At least $17.75
• Training Location/Schedule:
• On the job Training Monday-Friday core hours between 6:00am CT and 4:00pm CT
• Scheduled Shift: Flexible schedule once trained, 8-hours shifts between 6am-10pm
• Work Location: Remote and onsite options are available.
  
  

How do I know this opportunity is right for me? If you:

• Have processed adjustments according to TRICARE Policy by making an additional payment, reissue, or statistical adjustment.
• Like to identify and credit refunds to correct claim history. Contact beneficiaries, providers, and other agencies as necessary to obtain information to ensure refunds are posted to correct account.
• Can request recoupment of payments in accordance with TRICARE Policy and Operational Manual.
• Enjoy responding to correspondence from internal and external customers to include departments within MVH Division, attorneys, insurance companies, TRICARE Management Activity (TMA), government agencies, and prime contractors.
• Can coordinate benefits with commercial insurance, Medicare, and other plans.
• Like to review computer generated and inventory reports to prioritize workflow to ensure claims processing timeline standards are met.
• Have reported aging inventory concerns or system issues to supervisor or unit coordinator.
• Enjoy processing adjustments and credits with an understanding of TRICARE Encounter Data editing requirements imposed by TMA.
• Like to review claims to determine if processing is correct according to automated claims processing system’s methodology for pricing, reimbursement, and cost-sharing.
• Have interpreted legal documents for payments involving judgments such as custodial or bankruptcy.
• Enjoy making recommendations for process improvements by filing an Improvement Corrective Preventative Action (ICPA) and Potential Non-Conformance (PNC) forms.
• Can complete Sponsor Patient Information Updates (SPIU) accordingly.
  
  

Minimum Qualifications

• U.S. Citizenship is required for this position due to Department of Defense restrictions.
• High school diploma or equivalent.
• 1 or more years recent TRICARE claims entry (claims support) or processing OR
• 2 or more years office experience involving account reconciliations and customer contact including bookkeeping, billing, or financial services.
• Possess data entry and 10-key skills Ability to learn and apply TRICARE benefits, Policy, Operations Manual, and federal regulations.
• Ability to learn TRICARE claims processing methodologies and systems in resolution of payment errors.
• Ability to interpret legal documents and documents from primary insurance.
  
  

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.
  
  

Benefits

• Bargaining Unit position
• 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: (https://www.wpshealthsolutions.com/careers/)
  
  

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, 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 has been making healthcare easier for the people we serve for nearly 80 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 open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique 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.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

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TRICARE (MVH)

This position supports services under U.S. Department of Defense (DoD) Defense Health Agency (DHA) contract(s).  As such, the role is subject to all applicable federal regulations, DoD contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity.  DoD contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.