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Senior Risk Adjustment Auditor Jobs in Wisconsin

WI · On-site

$240 - $270/hr

Serve as the senior compliance advisor to executive leadership on pharmacy regulatory matters ... Oversee compliance monitoring, auditing, and reporting programs to assess effectiveness and ...

... internal controls, risk management, and business operations. * Oversee multiple concurrent ... Provide technical leadership on complex accounting, auditing, and financial reporting matters while ...

Senior Accountant

Oak Creek, WI · On-site

$70K - $88K/yr

... adjustments as needed. * Assist in coordination with the external tax team to prepare and ... Company's independent auditors and for various lender agreements. * Prepare and deliver ...

Senior Assurance Manager

Madison, WI · On-site

$140K - $160K/yr

... internal controls, risk management, and business operations. * Oversee multiple concurrent ... Provide technical leadership on complex accounting, auditing, and financial reporting matters while ...

Ability to analyze and interpret laboratory tests for the purpose of making operational decisions or adjustments. * Demonstrated leadership ability including ability to effectively speak and present ...

Director, Actuarial Services

Madison, WI · On-site

$150K - $257K/yr

For more senior positions, this also requires the ability and willingness to work with the segments ... Incorporates the impact of risk adjustment into financial projections and performance analysis

Director, Actuarial Services

Madison, WI · On-site

$150K - $257K/yr

For more senior positions, this also requires the ability and willingness to work with the segments ... Incorporates the impact of risk adjustment into financial projections and performance analysis

Senior Accountant

Oak Creek, WI · On-site

$70K - $88K/yr

... adjustments as needed. * Assist in coordination with the external tax team to prepare and ... Company's independent auditors and for various lender agreements. * Prepare and deliver ...

WI · On-site

$115.40 - $192.30/hr

LexisNexis Risk Solutions**We develop industry-leading solutions that are pro-people, anti-fraud ... If you have a disability or other need that requires accommodation or adjustment, please let us ...

Showing results 41-60

Senior Risk Adjustment Auditor information

What is a senior risk adjustment auditor?

Senior Risk Adjustment Auditors are experienced professionals who review medical records and data to ensure accurate coding and documentation for risk adjustment purposes, primarily in healthcare settings. They help organizations comply with government regulations and maximize appropriate reimbursement by identifying and correcting coding errors or gaps. Their role involves analyzing patient data, collaborating with coding teams, and providing feedback or training to improve documentation practices. Senior auditors often have advanced knowledge of ICD-10-CM coding, risk adjustment models (such as HCC), and auditing standards. Their expertise helps healthcare organizations maintain compliance and optimize financial performance.

How does a senior risk adjustment auditor typically collaborate with coding teams and healthcare providers to ensure accurate documentation and coding?

A Senior Risk Adjustment Auditor often works closely with medical coding teams and healthcare providers to review patient records for accuracy and compliance with risk adjustment guidelines. This collaboration may involve providing feedback on documentation quality, clarifying coding ambiguities, and offering training or guidance on best practices. Regular meetings and audits help ensure that everyone is aligned with current regulations and organizational standards. Effective communication and teamwork are essential to maintain high-quality, compliant coding that supports proper reimbursement and patient care.

What are the key skills and qualifications needed to thrive as a senior risk adjustment auditor?

To thrive as a Senior Risk Adjustment Auditor, you need deep expertise in medical coding (ICD-10-CM), risk adjustment methodologies, and a background in healthcare compliance, typically supported by certifications such as CRC, CPC, or CCS-P. Familiarity with auditing platforms, data analysis tools, and electronic medical records systems is crucial. Exceptional attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and effectively collaborate with providers. These competencies ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.

What is the difference between Senior Risk Adjustment Auditor vs Risk Adjustment Auditor?

AspectSenior Risk Adjustment AuditorRisk Adjustment Auditor
CertificationsCPMA, RAC, or similarCPMA, RAC, or similar
Work EnvironmentHealthcare organizations, insurance companies, consulting firmsHealthcare providers, insurance companies, auditing firms
Job ResponsibilitiesLeading audits, mentoring, complex data analysisPerforming audits, data review, compliance checks

Both roles require similar certifications and work in healthcare or insurance settings. The Senior Risk Adjustment Auditor typically handles more complex audits, provides mentorship, and takes on leadership tasks, whereas the Risk Adjustment Auditor focuses on executing audits and data analysis. The senior role involves greater responsibility and expertise, often leading to career advancement in risk adjustment auditing.

What are popular job titles related to Senior Risk Adjustment Auditor jobs in Wisconsin?

For Senior Risk Adjustment Auditor jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Senior Risk Adjustment Auditor jobs in Wisconsin look for?

The top searched job categories for Senior Risk Adjustment Auditor jobs in Wisconsin are:

What cities in Wisconsin are hiring for Senior Risk Adjustment Auditor jobs?

Cities in Wisconsin with the most Senior Risk Adjustment Auditor job openings:

Infographic showing various Senior Risk Adjustment Auditor job openings in Wisconsin as of August 2026, with employment types broken down into 100% Full Time. Highlights an 69% In-person, 8% Hybrid, and 23% Remote job distribution.

Sr Manager, Enterprise Risk and Investigations

Worldpay, Inc.

Milwaukee, WI

Full-time

Re-posted 4 days ago


Job description

Job Description

The world of finance moves fast. At FIS, we're faster. Our teams are empowered to learn, grow, and make an impact-in their careers and communities. We deliver innovation that advances the way the world pays, banks and invests. If you want to grow personally and professionally, we'd like to know: Are you FIS?

About the role:

The Senior Manager, Enterprise Fraud Compliance & Investigations, is a senior financial crime compliance and fraud leader responsible for overseeing fraud compliance strategy, complex fraud investigations, and fraud advisory across a diversified financial technology environment. This role supports businesses that provide issuer processing, core banking solutions, digital payments, treasury management, liquidity management, and capital markets platforms to banks, fintechs, broker-dealers, corporates, and other regulated financial institutions.

The successful candidate is a seasoned fraud and financial crime professional with experience operating in complex financial services or financial technology environments. In addition, the ideal candidate brings deep expertise across card fraud, payments fraud, deposit fraud, online banking fraud, treasury fraud, capital markets fraud, fraud detection technology, AML/fraud convergence, and complex investigations. This individual will serve as a trusted advisor to Compliance, Product, Technology, Operations, Client Management, Legal, Risk, and regulated entity leadership.

What you will be doing:

  • Assessing fraud risk at regulated entities and across issuer processing, core banking, treasury, liquidity, and capital markets products.
  • Leading or overseeing complex fraud investigations involving high-risk events, significant losses, organized fraud rings, internal fraud, cyber-enabled fraud, and emerging typologies.
  • Advising on fraud control design embedded in transaction authorization, onboarding, authentication, monitoring, case management, dispute handling, and regulatory reporting workflows.
  • Partnering with AML investigations teams to support unusual activity identification, escalation, SAR decisioning, and financial crime governance for regulated entities.
  • Translating complex fraud risks into practical, executive-ready guidance for business leaders, clients, auditors, and regulators, and influencing business, technology, and operations stakeholders.
  • Supporting regulatory exams, audits, and independent testing, and drive remediation of fraud control weaknesses.
  • Developing fraud governance, standards, and risk appetite metrics.

What you will need:

  • Issuer Processing and Card Fraud experience: The candidate should understand how fraud controls are applied across the card transaction lifecycle, including authorization scoring, rule strategies, velocity limits, authentication, fraud alerts, disputes, and exception handling. They should have strong knowledge of fraud risks across issuer processing and card products, including Debit, credit, prepaid, commercial, and private-label card fraud, Card-not-present fraud, Card-present fraud, Lost/stolen card fraud, Counterfeit card fraud, Card testing attacks, Tokenization and digital wallet fraud, Account takeover involving card products, Authorization fraud strategies, Clearing, settlement, disputes, and chargeback fraud considerations, and Visa, Mastercard, Discover, and other network fraud programs and rules.
  • Payments Fraud: The candidate should understand how fraud risk differs across consumer, small business, commercial, and institutional payment flows, and should have broad payments fraud expertise across traditional and emerging payment rails, including ACH fraud, Wire transfer fraud, RTP and FedNow fraud, P2P payment fraud, Digital wallet fraud, Business email compromise, Authorized push payment scams, Invoice redirection fraud, Payroll diversion schemes, Corporate payments fraud, Mule account activity, and Cross-channel fraud migration.
  • Core Banking and Deposit Fraud experience: Because the company develops core banking products, the candidate should understand fraud risks embedded in deposit and banking platforms, including New account fraud, Synthetic identity fraud, Identity theft, Account takeover, Check fraud, Mobile deposit fraud, Duplicate presentment, Check kiting, First-party fraud, Friendly fraud, Bust-out schemes, Online and mobile banking compromise, Credential stuffing and session hijacking, and Fraud risk within customer onboarding, account maintenance, funds availability, and transaction posting processes.
  • Treasury Management and Liquidity Product Fraud: The candidate should also bring knowledge of fraud risk in commercial and treasury environments, including Commercial account takeover, Treasury workstation compromise, Wire initiation fraud, Fraudulent ACH origination, Positive pay circumvention, Payment approval workflow abuse, Privileged user misuse, Fraudulent liquidity transfers, Cash concentration fraud, Settlement timing manipulation, Unauthorized cash sweeps, Fraud affecting corporate liquidity and treasury operations.
  • Capital Markets and Securities Fraud: For capital markets and securities-related products, the candidate should understand how fraud, operational risk, AML, and market conduct risks intersect in capital markets environments, such as Unauthorized trading, Insider trading indicators, Market manipulation, Wash trading, Spoofing and layering, Client asset transfer fraud, Custody-related fraud, Investment account takeover, and Beneficiary change fraud, Distribution fraud, Fraud risks affecting broker-dealers, custodians, asset managers, and institutional trading platforms, and Employee misconduct.
  • Fraud Technology and Analytics Expertise: The candidate should have experience with fraud detection, identity verification, authentication, and transaction monitoring technologies, across different industry platforms. The candidate should understand Fraud rule writing and tuning, Alert optimization, Model performance monitoring, Fraud scoring, Behavioral analytics, Device intelligence, Risk-based authentication, Machine learning fraud detection, False-positive management, Fraud capture rates, Approval-rate impact, Fraud loss and basis-point reporting, and Portfolio segmentation and trend analytics.
  • Fraud Investigations Oversight: The candidate should have strong working knowledge of how fraud activity intersects with AML obligations and suspicious activity reporting. This includes experience with Fraud-to-AML referrals, Mule account networks, Fraud proceeds laundering, Human trafficking indicators, Elder financial exploitation, Romance scams, Business email compromise laundering, Cybercrime-related payments, Synthetic identity networks, Authorized push payment scams, Unusual activity escalation, SAR decision support, and Financial crime typology development. The candidate should be able to coordinate effectively with centralized AML investigations teams and BSA/AML Officers supporting regulated entities.
  • Regulatory and Compliance Knowledge: The candidate should have working knowledge of fraud-related regulatory and compliance expectations, including Regulation E, Regulation Z, UDAAP, BSA/AML requirements, Suspicious activity reporting expectations, FFIEC guidance, PCI-DSS, OCC, FDIC, Federal Reserve, FinCEN, SEC, and FINRA expectations, as applicable; Payment network rules and chargeback frameworks; Model risk and governance considerations for fraud tools and analytics.

Required Experience:

  • 10+ years of experience in fraud risk management, financial crime compliance, investigations, payments risk, issuer processing, banking technology, capital markets operations, or related financial services roles.
  • Experience supporting banks, fintechs, issuer processors, payment processors, broker-dealers, core banking platforms, treasury platforms, or financial technology providers.
  • Demonstrated experience overseeing or supporting complex fraud investigations.
  • Strong understanding of payments, card processing, core banking, treasury, liquidity, and/or capital markets products.
  • Experience with fraud detection systems, fraud analytics, rules strategies, alert management, and investigative case management.
  • Ability to work across Compliance, Product, Technology, Risk, Operations, Legal, and Client-facing teams.
  • Strong executive communication, analytical, and stakeholder management skills.
  • Familiarity with AI-enabled fraud, deepfakes, behavioral biometrics, machine learning fraud detection, and cyber-fraud convergence.
  • Experience with SQL, advanced Excel, dashboarding, data visualization, or fraud analytics tools.

What we offer you:
At FIS, you can grow your career as far as you want to take it. Here's what else we offer:
Opportunities to make an impact in fintech
Personal and professional learning
Inclusive, diverse work environment
Resources to give back to your community
Competitive salary and benefits
An inclusive workspace built on collaboration, flexibility and respect.
A salary and benefits package that reflects your hard work.


Privacy Statement

FIS is committed to protecting the privacy and security of all personal information that we process in order to provide services to our clients. For specific information on how FIS protects personal information online, please see the Online Privacy Notice.

EEOC Statement

FIS is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, genetic information, national origin, disability, veteran status, and other protected characteristics. The EEO is the Law poster is available here supplement document available here


For positions located in the US, the following conditions apply. If you are made a conditional offer of employment, you will be required to undergo a drug test. ADA Disclaimer: In developing this job description care was taken to include all competencies needed to successfully perform in this position. However, for Americans with Disabilities Act (ADA) purposes, the essential functions of the job may or may not have been described for purposes of ADA reasonable accommodation. All reasonable accommodation requests will be reviewed and evaluated on a case-by-case basis.

Sourcing Model

Recruitment at FIS works primarily on a direct sourcing model; a relatively small portion of our hiring is through recruitment agencies. FIS does not accept resumes from recruitment agencies which are not on the preferred supplier list and is not responsible for any related fees for resumes submitted to job postings, our employees, or any other part of our company.

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