Family Savings Plan Claims Analyst

Description

The Family Savings Plan (FSP) Claims Analyst is responsible for the accurate and timely entry, processing, adjudication, and auditing of medical and pharmacy claims. This role supports end-to-end claims operations and ensures compliance with established policies, procedures, contractual requirements, and regulatory guidelines while contributing to operational excellence and service quality.

Key responsibilities include high-volume data entry of medical and pharmacy claims, detailed claims review and adjudication, quality audits, and participation in training and continuous improvement initiatives. The analyst plays a critical role in maintaining data integrity, identifying discrepancies, and ensuring accuracy and consistency across claims systems and processes.

This position requires strong collaboration with cross-functional stakeholders across multiple levels of the organization to support strategic objectives, operational efficiencies, and service excellence. The FSP Claims Analyst may also assist with benefit interpretation, in-depth review and analysis of medical and pharmacy claims, and comprehensive claims research to resolve complex issues, discrepancies, or inquiries.

Additionally, the individual is expected to effectively communicate findings and recommendations, demonstrate strong analytical and problem-solving abilities, and handle confidential and sensitive information with professionalism and discretion. A commitment to accuracy, productivity, accountability, and customer-focused service is essential in supporting organizational priorities and delivering high-quality claims management outcomes.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model. Travel to the office in Menasha or Brookfield will be required occasionally for the position, including on first day.

Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Perform accurate and timely data entry of member- and provider-submitted medical and pharmacy claims.
• Process medical and pharmacy claims in accordance with established policies, procedures, contractual requirements, and regulatory guidelines.
• Audit claims to ensure accuracy in data entry, coding, and payment, identifying and correcting discrepancies as needed.
• Demonstrate behaviors consistent with Network Health's mission, vision, values, and organizational philosophy.
• Respond to internal inquiries regarding claim status, issues, and benefit interpretation within established turnaround times (typically within 24 hours) to meet departmental metrics and contractual standards.
• Proactively follow up with internal departments to resolve outstanding issues or concerns, and appropriately escalate complex or unresolved matters to a Supervisor or designated contact.
• Maintain strong attention to detail, accuracy, and productivity standards while handling sensitive and confidential information.
• Perform additional duties and responsibilities as assigned to support departmental and organizational goals.
  
  

Job Requirements:

• HS Diploma required, associate degree preferred
• 2+ Years working in the health insurance industry preferred
• Data entry, medical and pharmacy claims processing experience strongly preferred
• Medical terminology experience preferred

Network Health is an Equal Opportunity Employer

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Required

Preferred

Job Industries

• Other