Join WPS Health Solutions as a pivotal Remote Clinical Review Nurse – Medicare Appeals Specialist! We are seeking a highly skilled and dedicated Registered Nurse (RN) to join our growing team in a fully remote capacity. This is an exciting opportunity to leverage your clinical expertise and analytical abilities to ensure the accuracy and integrity of Medicare Part A and Part B appeals. Our state-of-the-art remote workspace provides a comfortable and productive environment for you to excel.
WPS Health Solutions is a leading not-for-profit health insurer and a trusted federal government contractor headquartered in Wisconsin. For over 75 years, we have been committed to making healthcare easier for the individuals and communities we serve. We provide comprehensive health insurance plans for individuals, families, seniors, and group health plans for businesses of all sizes. A significant portion of our work involves processing claims and providing vital customer support for Medicare beneficiaries, as well as managing benefits for millions of active-duty and retired military personnel across the U.S. and internationally. We are deeply proud of our strong connection to the military community and are committed to being a veteran-ready employer.
At WPS, our culture is the foundation of our success. We foster an inclusive and empowering employee experience where innovation and collaboration thrive. We champion Diversity, Equity, and Inclusion as core values, recognizing that diverse perspectives are essential for agility and innovation. We believe in creating an environment where every employee feels valued and can bring their authentic selves to work. This commitment has been recognized through numerous accolades, including being named a top workplace in Madison, Wisconsin, and receiving national recognition for our remote work culture and employee engagement. We are proud to be a DAV Patriot Employer and a 4-Star Employer with VETS Indexes, as well as recognized for our ethical business practices by the Better Business Bureau.
As a Remote Clinical Review Nurse – Medicare Appeals Specialist, you will play a critical role in the first-level review of Medicare Part A and Part B appeals. Your expertise will be essential in examining medical records and claims information to determine if the services provided meet Medicare coverage guidelines and are medically necessary. Your key responsibilities will include:
This role is an excellent fit if you:
This position offers a rewarding opportunity to:
To be considered for this position, you must meet the following minimum qualifications:
The following qualifications are highly desirable:
To ensure seamless remote work, you must have:
The base salary for this position ranges from $66,000 to $68,000 per year. Your specific starting salary within this range will be determined based on your qualifications, skills, and experience.
This is a full-time, salaried position with a flexible work schedule. You will work Monday through Friday, with production hours between 6:00 AM and 6:00 PM Central Standard Time (CST). Flexibility in your daily start and end times is available, provided you work a total of 40 hours per week within these production hours. The initial training period is approximately 2 to 3 months and will be conducted remotely, typically Monday through Friday from 8:00 AM to 4:00 PM CST (hours may vary slightly).
WPS Health Solutions is a remote-first organization and offers remote work in the following states: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, and Wisconsin.
We offer a comprehensive benefits package, including:
If you are a highly motivated and skilled clinical nurse looking for a rewarding remote career, we encourage you to apply! We are excited to review your application.
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