FRAUD WASTE ABUSE ANALYST - ASPIRUS HEALTH PLAN

Compassion. Accountability. Collaboration. Foresight. Joy.

These are the Aspirus Core Values; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day.

Aspirus Health in Wausau, WI is seeking a FRAUD WASTE ABUSE ANALYST to join our ASPIRUS HEALTH PLAN team!

The FWA Analyst plays a critical role in protecting the organization from improper billing, abusive practices, and potential fraud. This position conducts detailed reviews of medical claims, provider patterns, and member activity to identify anomalies and ensure compliance with regulatory, contractual, and clinical standards.

The analyst will work closely with Senior Claims Analysts, the SIU, and cross‑functional teams to support investigations, recommend corrective actions, and strengthen internal controls. A clinical background, particularly as an RN, along with utilization management and claims is strongly preferred to support accurate clinical interpretation of documentation and coding.

HOURS: Full-Time or 1.0 FTE, 80 hours every 2 weeks.

Experience/Qualifications

Required Qualifications

• Bachelor’s degree is required.

• Active RN license is strongly preferred; LPN or other clinical credentials may be considered.

• Minimum of two years’ experience in health insurance claims analysis or related experience required.

Preferred Qualifications

• Experience in SIU, FWA investigations, or compliance within a payer or provider environment.

• Knowledge of CPT, HCPCS, and ICD‑10 coding and medical terminology.

• Familiarity with CMS, Medicare, and commercial plan regulations

• Strong analytical and problem‑solving skills with the ability to interpret complex data sets.

• Excellent written and verbal communication skills for reporting and cross‑department collaboration.

• Proficiency with claims platforms and data tools such as Facets, ClaimsXten, Excel, or similar systems.

• Background in clinical case management or utilization review.

Employee Benefits

• Full benefits packages available for part- and full-time status.

• Time away from work accrual.

• Retirement plans available.

• Wellness program for employees and their families.

Our Mission : We heal people, promote health and strengthen communities.

Our Vision : Aspirus is a catalyst for creating healthy, thriving communities, trusted and engaged above all others.

As an Aspirus team, we demonstrate caring, we plan to impact the future, work with happiness and enthusiasm, recognize our power to make a difference and improve the health of our communities.

Aspirus Health is a nonprofit, community-directed health system based in Wausau, Wisconsin, serving northeastern Minnesota, northern and central Wisconsin and the Upper Peninsula of Michigan. The health system operates 18 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians. For more information visit aspirus.org.

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Position FRAUD WASTE ABUSE ANALYST - ASPIRUS HEALTH PLAN

Location

Req ID 104691