Fraud & Abuse Claims Examiner (RN/LPN) – Remote

Wis Phys Svc Ins Corp; Madison (WI); Presencial; USD 22.000 - 31.000; A tiempo parcial

Ventajas ofrecidas por este puesto de trabajo

Performance bonus

401(k) match up to 6%

Health, dental & telehealth from Day 1

Paid time off

Descripción de la vacante

Wis Phys Svc Ins Corp seeks a Claims Examiner III, Fraud and Abuse (LPN) to join our Madison area team. This part-time role supports MVH management, researches abuse patterns, and coordinates investigations while ensuring only medically appropriate MVH benefits are paid.

Must live within 45 miles of the Madison campus and be licensed as RN or LPN. The position offers remote work options with onsite training in Madison, WI, and a competitive hourly rate of $19.35.

Formación

• Must live within vicinity of Madison, WI campus location.
• U.S. citizenship required due to DoD restrictions.
• Licensed RN or LPN with active licensure.

Responsabilidades

• Identify, develop, and report fraudulent or abusive practices.
• Provide support to MVH Management for investigations.
• Refer cases to law enforcement as needed.
• Audit claims and medical records for medical necessity.
• Communicate with beneficiaries, providers, and contractors.
• Prepare professional letters and data for review.

Conocimientos

Data analysis

Report generation

Regulatory knowledge

Educación

RN or LPN licensure

Descripción del empleo

Wis Phys Svc Ins Corp seeks a Claims Examiner III, Fraud and Abuse (LPN) to join our Madison area team. This part-time role supports MVH management, researches abuse patterns, and coordinates investigations while ensuring only medically appropriate MVH benefits are paid.

Must live within 45 miles of the Madison campus and be licensed as RN or LPN. The position offers remote work options with onsite training in Madison, WI, and a competitive hourly rate of $19.35.