Claims Processing Specialist

About Health Payment Systems, Inc. (HPS/PayMedix)
Health Payment Systems, Inc. (HPS/PayMedix) is redefining how people access and pay for healthcare. We bring together provider networks, payments and financing, and industry partners to remove financial barriers and simplify the healthcare experience for everyone involved.

Our team is solving one of the biggest challenges in healthcare: the flow of money and information between providers and consumers. The work we do improves access, reduces financial stress, and is reshaping how healthcare works at its most fundamental level.

Our solutions include:

• HPS Network: a high-performing, independent provider network in Wisconsin that helps employers control costs whilemaintainingstrong access to care.
• PayMedix: a national healthcare payments platform that pays providers in full, consolidates medical information and billing, and offers members interest-free financing for all in-network costs
• TempoPay: a flexible healthcare benefit solution that gives eligible individuals a simple, predictable way to pay for care over time, with zero interest or fees.

Join us in our mission to make the healthcare payments experience simpler, more transparent, and more connected – so people can focus on getting care when they need it, not when they think they can afford it.

About The Role
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).

Primary 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.

Required Qualifications

• 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.

Key Attributes for Success

• Attention to Detail & Accuracy: Able to spot inconsistencies, validate information, and ensure claims are processed correctly as this is critical to success in the role.
• Ownership & Accountability: Takes responsibility for outcomes, follows through on issues, and steps in to support team priorities when needed.
• Cross-Functional Collaboration: Demonstrates strong cross-functional collaboration while adapting quickly and contributing effectively in a fast-paced, high-growth environment.

Other Important Details

• Compensation:

• $22.00 to $24.00 Hourly
• Benefits: medical, dental, vision, HSA with company contribution, 401k/Roth with company match, 15 days of PTO, and more.
• Hybrid Work:
• 2–3 days onsite, subject to business needs
• Equal Opportunity & Workplace Environment:

• We are an equal opportunity employer and are committed to fostering an inclusive workplace where all employees can thrive. We consider applicants for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected characteristic under applicable law. Reasonable accommodations will be provided to qualified individuals with disabilities throughout the hiring process and during employment.
• This role is primarily performed in a professional office environment and typically involves working at a desk using a computer, phone, and other standard office equipment. The position requires regular communication with colleagues and stakeholders through phone, video, and written channels, as well as the ability to perform work using a computer. The role may also involve occasional movement around the office. Additional hours may occasionally be required to support key projects or business needs.