You’ll need
Licensure
Active RN license is strongly preferred
Certifications
✓LPN or other clinical credentials may be considered.
Education
✓Bachelor’s degree is required.
Qualifications
✓Minimum of two years’ experience in health insurance claims analysis or related experience required.
Experience in SIU, FWA investigations, or compliance within a payer or provider environment. preferred
Knowledge of CPT, HCPCS, and ICD‑10 coding and medical terminology. preferred
Familiarity with CMS, Medicare, and commercial plan regulations preferred
Strong analytical and problem‑solving skills with the ability to interpret complex data sets. preferred
Excellent written and verbal communication skills for reporting and cross‑department collaboration. preferred
Proficiency with claims platforms and data tools such as Facets, ClaimsXten, Excel, or similar systems. preferred
Background in clinical case management or utilization review. preferred
Benefits
Full benefits packages available for part- and full-time statusTime away from work accrualRetirement plans availableWellness program for employees and their families
More administration jobs near Wausau, WIMore administration jobs nearby
All 197 in Wisconsin →All 197 →Highest-paying administration roles in Wisconsin
Employer-posted ranges only
About the role
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.