Remote Claims Auditor III (RN/LPN) – Fraud & Compliance

WPS—A health solutions company; Minnesota; Remote; USD 25,000 - 35,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

Job summary

WPS Health Solutions is seeking a Claims Examiner III LPN to protect MVH program integrity by identifying, investigating, and preventing fraud, waste, and abuse. The role blends clinical expertise with data analysis to evaluate medical necessity and ensure appropriate benefit administration.

Remote-friendly with state approvals; requires US citizenship and RN/LPN licensure, plus 3+ years of clinical practice. Training occurs Mon-Fri 8am-4pm with flexible shifts after training.

Qualifications

• U.S. citizenship is required for this position per DoD restrictions.
• Licensed RN or LPN with current licensure.
• 3+ years of clinical practice experience.
• Ability to learn MVH regulations and procedures.
• Ability to analyze and document medical findings.

Responsibilities

• Analyze data from anti-fraud software and medical records to identify fraud, abuse or aberrant utilization patterns.
• Develop and manage investigative cases, reviewing claims histories and patterns.
• Perform pre- and post-payment reviews to determine medical necessity and compliance.
• Prepare data formats for physician and peer review; create audit summaries.

Skills

RN/LPN licensure

Clinical experience

Data analysis

Communication

Education

RN Licensure or LPN Licensure

Tools

MS Excel

Job description

WPS Health Solutions is seeking a Claims Examiner III LPN to protect MVH program integrity by identifying, investigating, and preventing fraud, waste, and abuse. The role blends clinical expertise with data analysis to evaluate medical necessity and ensure appropriate benefit administration.

Remote-friendly with state approvals; requires US citizenship and RN/LPN licensure, plus 3+ years of clinical practice. Training occurs Mon-Fri 8am-4pm with flexible shifts after training.