FRAUD WASTE ABUSE ANALYST

Aspirus, Inc; Town of Wausau (WI); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Full benefits packages

Time away from work accrual

Retirement plans

Wellness program

Job summary

Aspirus Health WAUSAU, WI seeks a Fraud Waste Abuse Analyst to join our Aspirus Health Plan team, protecting the organization from improper billing and fraud.

The analyst reviews medical claims, provider patterns, and member activity, collaborates with SIU and compliance, and supports investigations with recommended corrective actions.

Experience in claims analysis, CPT/HCPCS/ICD-10 knowledge, and tools like Facets, ClaimsXten, and Excel strengthen clinical interpretation and internal controls.

Qualifications

• Bachelor's or associate degree in healthcare, science, or business, or equivalent experience.
• 2+ years in medical chart review, claims analysis, or related field.
• Knowledge of CPT, HCPCS, and ICD-10 coding and medical terminology.
• Annual competencies as required by Aspirus/regulators.

Responsibilities

• Review medical claims and provider patterns to identify anomalies.
• Support investigations with Senior Claims Analysts, SIU, and compliance teams.
• Recommend corrective actions and strengthen internal controls.
• Interpret clinical documentation and coding for accurate interpretation.

Skills

Analytical thinking

Data interpretation

Communication

Healthcare claims analysis

Education

Associate degree in healthcare/science or business

Bachelor's degree in healthcare/science or business

Tools

Facets

ClaimsXten

Excel

Job description

Compassion. Accountability. Collaboration. Foresight. Joy.

These are the Aspirus Core Values; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day.

Aspirus Health WAUSAU, WI is seeking a FRAUD WASTE ABUSE ANALYST to join our ASPIRUS HEALTH PLAN team!

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.

The analyst will work closely with Senior Claims Analysts, the SIU, compliance and cross‑functional teams to support investigations, recommend corrective actions, and strengthen internal controls. Utilization Management and claims background is strongly preferred to support accurate clinical interpretation of documentation and coding.

HOURS: Full Time, 1.0 FTE, 80 hours every two weeks

Required Qualifications

• Associate or bachelor's degree in a healthcare, science, or business related field preferred; or equivalent professional experience in clinical documentation, health information, or medical chart review.


• 2+ years of experience working with medical charts, clinical documentation, health insurance claims analysis or related experience.


• Knowledge of CPT, HCPCS, and ICD‑10 coding and medical terminology.


• Annual competencies as required by Aspirus and/or various regulatory agencies based on entity and/or job position.

Preferred Qualifications

• Experience in SIU, FWA investigations, or compliance within a payer or provider environment.


• Familiarity with CMS, Medicare, and commercial plan regulations


• Strong analytical and problem‑solving skills with the ability to interpret complex data sets.


• Excellent written and verbal communication skills for reporting and cross‑department collaboration.


• Proficiency with claims platforms and data tools such as Facets, ClaimsXten, Excel, or similar systems.


• Background in clinical case management or utilization review.

Employee Benefits

• Full benefits packages available for part- and full-time status.


• Time away from work accrual.


• Retirement plans available.


• Wellness program for employees and their families.

Our Mission: We heal people, promote health and strengthen communities.

Our Vision: Aspirus is a catalyst for creating healthy, thriving communities, trusted and engaged above all others.

As an Aspirus team, we demonstrate caring, we plan to impact the future, work with happiness and enthusiasm, recognize our power to make a difference and improve the health of our communities.

Aspirus Health is a nonprofit, community-directed health system based in Wausau, Wisconsin, serving northeastern Minnesota, northern and central Wisconsin and the Upper Peninsula of Michigan. The health system operates 18 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians. For more information visit aspirus.org.

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