Program Integrity Jobs in Wisconsin (NOW HIRING)

Role Snapshot

Process all MVH overseas claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), DEERS eligibility, and claims development.

Additional Information

• Start Date: Tuesday August 11
• Starting Base Salary: $17.75/hour
• Training Schedule: 8:00am-4:35pm CST Monday-Friday (4 weeks)
• Scheduled Shift: Flexible schedule once metrics have been obtained, 8-hours shifts between 6am-10pm CST
• Work from Home: Currently able to work from home, including training (not considered a permanent remote position). Must reside within a 45-mile radius of Madison, WI WPS Campus

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

• Process all MH overseas claim types by determining corrective action to be taken on various types of errors pended by edit system and resolving interactive edits.
• Translate, research, and verify claims information to determine if all requirements have been met.
• Review submitted claim information and select correct procedure code and diagnosis code using ICD-9, ICD-10, CPT4, and HCPCS manuals.
• Obtain development information from external contacts and add successful development information to notepad via PC.
• Access patient/sponsor files and update information accordingly.

Minimum Qualifications

• High School Diploma or GED or equivalent experience.
• US. citizenship is required for this position due to Department of Defense restrictions
• One (1) or more years of experience in a claims processing role.
• Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy.
• Ability to effectively utilize available resources to further research and verify claims.
• Strong written communication skills.
• Demonstrates the ability to work independently and take initiative.

Preferred Qualifications

• Ability to translate a foreign language.
• Two (2) or more years of prior health insurance experience, i.e., Claims Processor, Customer Service Representative, or Billing Representative preferred.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber
• 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 work 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 here

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.