COB & Recovery Analyst
Menasha, WI · On-site +1
Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of ... Acts as a liaison between Payment Integrity and other operational departments for claim recovery ...
COB & Recovery Analyst
Menasha, WI · On-site +1
Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of ... Acts as a liaison between Payment Integrity and other operational departments for claim recovery ...
COB & Recovery Analyst
Menasha, WI · On-site +1
Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of ... Acts as a liaison between Payment Integrity and other operational departments for claim recovery ...
COB & Recovery Analyst
Menasha, WI · On-site +1
Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of ... Acts as a liaison between Payment Integrity and other operational departments for claim recovery ...
COB & Recovery Analyst
Menasha, WI · On-site +1
Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of ... Acts as a liaison between Payment Integrity and other operational departments for claim recovery ...
COB & Recovery Analyst
Menasha, WI · On-site +1
Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of ... Acts as a liaison between Payment Integrity and other operational departments for claim recovery ...
Senior Quality Analyst
Madison, WI · Remote
$66K - $83K/yr
As a Senior Quality Analyst , you'll play a critical role in protecting operational excellence ... payment integrity * Build advanced expertise across multiple business systems and operational ...
Senior Quality Analyst
Madison, WI · Remote
$66K - $83K/yr
As a Senior Quality Analyst , you'll play a critical role in protecting operational excellence ... payment integrity * Build advanced expertise across multiple business systems and operational ...
Senior Quality Analyst
Madison, WI · Remote
$66K - $83K/yr
As a Senior Quality Analyst , you'll play a critical role in protecting operational excellence ... payment integrity * Build advanced expertise across multiple business systems and operational ...
Senior Quality Analyst
Madison, WI · Remote
$66K - $83K/yr
As a Senior Quality Analyst , you'll play a critical role in protecting operational excellence ... payment integrity * Build advanced expertise across multiple business systems and operational ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
$20/hr
... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...
Remote Payment Integrity Analyst information
What is a remote payment integrity analyst?
A Remote Payment Integrity Analyst is a professional who works from a remote location to review healthcare or insurance claims for accuracy, compliance, and potential fraud. Their primary role is to ensure that payments made by insurance companies or healthcare providers are correct and align with policy guidelines. They use data analysis, auditing processes, and investigative techniques to identify improper payments or billing errors. This helps organizations recover overpayments, prevent financial losses, and maintain regulatory compliance. Remote Payment Integrity Analysts typically work for health insurers, government agencies, or third-party vendors.
How does a remote payment integrity analyst typically collaborate with other departments to resolve payment discrepancies?
As a Remote Payment Integrity Analyst, you'll regularly work with teams such as billing, claims, and provider relations to investigate and resolve payment discrepancies. Clear communication—often via email, virtual meetings, or internal platforms—is crucial for gathering documentation, clarifying complex cases, and ensuring timely resolution. Collaboration may also involve sharing findings or trends to help improve overall payment processes and prevent future errors. This cross-functional teamwork is essential for maintaining accuracy and compliance in healthcare or insurance payment systems.
What are the key skills and qualifications needed to thrive as a remote payment integrity analyst, and why are they important?
To excel as a Remote Payment Integrity Analyst, you need strong analytical skills, experience in healthcare claims or payment analysis, and a bachelor’s degree in a related field. Familiarity with data analysis tools (such as Excel, SQL, or claims processing systems) and knowledge of industry regulations like HIPAA are typically required. Attention to detail, problem-solving abilities, and effective communication are vital soft skills for investigating discrepancies and collaborating with stakeholders. These competencies ensure the accurate identification of improper payments, cost savings, and compliance within healthcare organizations.
What is the difference between Remote Payment Integrity Analyst vs Remote Claims Auditor?
| Aspect | Remote Payment Integrity Analyst | Remote Claims Auditor |
|---|---|---|
| Required Credentials | Certifications in healthcare compliance, coding, or auditing | Certifications in claims processing, auditing, or healthcare reimbursement |
| Work Environment | Remote, healthcare or insurance companies | Remote, insurance or healthcare organizations |
| Industry Usage | Healthcare payers, insurance companies | Insurance companies, third-party administrators |
| Common Search Intent | Understanding roles in payment integrity and fraud prevention | Auditing claims for accuracy and compliance |
The Remote Payment Integrity Analyst focuses on detecting and preventing improper payments, fraud, and abuse within healthcare claims, often requiring compliance and coding certifications. In contrast, the Remote Claims Auditor reviews claims for accuracy and adherence to policies, typically with auditing certifications. Both roles are remote, industry-specific, and involve analyzing healthcare or insurance claims, but they emphasize different aspects of claims management and compliance.
What are the most commonly searched types of Payment Integrity Analyst jobs in Wisconsin?
The most popular types of Payment Integrity Analyst jobs in Wisconsin are:
What are popular job titles related to Remote Payment Integrity Analyst jobs in Wisconsin?
For Remote Payment Integrity Analyst jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Payment Integrity Analyst jobs in Wisconsin look for?
The top searched job categories for Remote Payment Integrity Analyst jobs in Wisconsin are:
What cities in Wisconsin are hiring for Remote Payment Integrity Analyst jobs?
Cities in Wisconsin with the most Remote Payment Integrity Analyst job openings:
Network Health rating
7.9
Based on 5 frontline employees who took The Breakroom Quiz
185th of 312 rated insurance
Job description
Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of refunds and recoveries and Medicare Part D coordination of benefits to maintain and drive improvements to our refund and recovery operations and Medicare Part D COB process.
Individuals in this role will help develop departmental policies and procedures to be followed. Investigates potential refunds and processes requests from Providers and Members due to overpayment or inaccurate payments due to COB or various other reasons. Medicare Part D COB is responsible for accurate coordination to ensure our PBM has correct information, preventing members from prescription delays.
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). Travel to the corporate office in Menasha 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:
Job Requirements:
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.
Individuals in this role will help develop departmental policies and procedures to be followed. Investigates potential refunds and processes requests from Providers and Members due to overpayment or inaccurate payments due to COB or various other reasons. Medicare Part D COB is responsible for accurate coordination to ensure our PBM has correct information, preventing members from prescription delays.
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). Travel to the corporate office in Menasha 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:
- Maintain reports for tracking voluntary refunds, recoup requests and the negative vendor report
- Keeps current on all business programs, including, products offered, group contracts and certificates, provider discounts, percentages and per diems, authorizations, and other utilization management policies, etc.
- Acts as a liaison between Payment Integrity and other operational departments for claim recovery issue resolution.
- Reviews and follows up on open work items to ensure resolution is within established timeframes
- Works closely with refunds and recoveries to identify root-cause for COB related refunds and recoveries
- Assumes responsibility for accuracy, timeliness and efficiency of COB claims following established guidelines
- Assist other departments with COB/Medicare Part D appropriate claims payment questions and helps resolve claims adjudication disputes related to COB
- Identifies and reports issues with COB/MSP identification or processing training and assists in addressing COB training opportunities.
- Works professionally with members, employers, providers, other insurance carriers and CMS with regard to verification and update of member information to ensure accuracy
- Manage monthly and annual Medicare Part D letters and corresponding updates with ESI
- Responsible for complete and accurate documentation of all information received in all applicable member records and databases
- Assists leadership in decision-making and provides all relevant information accurately and timely
- Ensures department desk procedures related to role are current and complete
- Review and respond to CMS Demand Letters for group health plans
- Assists in addressing training opportunities
- Actively participates in shared accountability and commitment for departmental and organization-wide results. Support departmental/team goals and objective
Job Requirements:
- Minimum of 3 years combined operations/customer service experience within the health insurance industry
- 1-3 years COB, Claims, Refunds and Recoveries or related work
- Excellent communication, critical thinking, and decision-making skills
- Knowledge of process improvement/maximum operational efficiency preferred
- Proficiency in MS Word, Excel, Outlook
- Working knowledge of COB, MSP and Medicare Part D
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.
About Network Health
Sourced by ZipRecruiter
Industry
Insurance services
Company size
201 - 500 Employees
Headquarters location
Menasha, WI, US
Year founded
1982