Senior Overpayment Recovery Specialist

WPS Health Solutions; Monona (WI); Hybrid; USD 37,000 - 42,000; Full time

Benefits offered by this job

Remote work options available

401(k) with match

Health insurance

Paid time off

Telehealth services

Job summary

WPS Health Solutions in Wisconsin seeks a Senior Overpayment Recovery Specialist to support the Overpayment Recovery Team with work direction, workflow, inventory, and coordination of activities. The role advises and assists staff, resolving complex issues and driving timely recovery outcomes.

The position entails mentoring staff, preparing daily/weekly/monthly operations reports, interpreting regulations, supporting audits, and maintaining compliance with Privacy Act and HIPAA.

Qualifications

• High School Diploma or equivalent.
• Two (2) years Medicare Financial/Overpayment Recovery experience with proficiency in all overpayment recovery areas.
• Knowledge of Overpayment Recovery Regulations, including coordination of benefits, financial cash receipts/recovery regulations and procedures, HIGLAS system, claims processing guidelines, edit resolution, and online systems.
• Knowledge of how to interpret regulations and apply them to process manuals, work instructions, and departmental guidelines.
• Knowledge of internal/external audit procedures, quality review standards, and audit documentation requirements.
• In-depth knowledge of insurance, payment recovery, reimbursement processes, and overpayment case workflow.
• Strong written and verbal communication skills for mentoring staff, preparing reports, and documenting procedures.
• Skilled in researching and resolving complex financial or recovery-related case situations with sound judgment.
• Ability to train new employees, provide ongoing coaching, and support team development.
• Ability to collaborate effectively in internal and external audit activities and support cross-functional teams.

Responsibilities

• Assist supervisor with monitoring, working, analyzing, and escalating department workload inventories for timely handling.
• Assist supervisor with mentoring new employees and providing process training.
• Support the preparation of daily, weekly, and monthly operations reports, including those related to Recovery Audit activities.
• Assist with interpretation of regulations and development/revision of work instructions and process manuals.
• Research and respond to complex Overpayment Recovery or financial case situations.
• Perform audits and/or quality reviews of unit completed work.
• Assist with internal and external audit processes, including OMB-A123, SSAE-16, ISO Surveillance, and Internal Audit reviews.

Skills

Communication

Analytical thinking

Mentoring

Training

Audits

Regulatory knowledge

Education

High School Diploma

Job description

Role Snapshot

The Senior Overpayment Recovery Specialist will assist the Overpayment Recovery Team with work direction, workflow, inventory, and coordination of activities and processes within the department. The role will advise and assist employees in the unit and support the resolution of difficult or complex issues.

Additional Information

• Start Date: September 22 2026
• Starting Base Salary: $19.00/hr. Pay may fluctuate with experience.
• Training Location/Schedule: Formal training first two weeks, with non-formal training after. Training shift is either 7:30am-4pm CT or 8am-4:30am CT.
• Scheduled Shift: Production hours 6am-8pm CT. 8-hour shift within this time frame.
• Work Location: You must live within 45 miles of Madison, even though this position is mostly remote.

How do I know this opportunity is right for me? If you enjoy the following:

• Assist supervisor with monitoring, working, analyzing, and escalating department workload inventories for timely handling.
• Assist supervisor with mentoring new employees and providing process training.
• Support the preparation of daily, weekly, and monthly operations reports, including those related to Recovery Audit activities.
• Assist with interpretation of regulations and development/revision of work instructions and process manuals.
• Research and respond to complex Overpayment Recovery or financial case situations.
• Perform audits and/or quality reviews of unit completed work.
• Assist with and/or participate in departmental internal and external audit processes, including OMB-A123, SSAE-16, ISO Surveillance, and Internal Audit reviews.
• Assist with ensuring jurisdictional process consistency, including process manuals and work instructions. Provide technical assistance by identifying and reporting system problems and testing system changes.
• Ensure compliance with Federal Privacy Act, HIPAA, and WPS conflict of interest and confidentiality requirements within daily work assignments.
• Provide necessary back-up by performing duties assigned to the Payment Recovery Representative, Payment Recovery Specialist, Reimbursement Analyst, Senior Reimbursement Analyst, and MSP Senior Analyst.
• Other job-related responsibilities may be assigned as required.

Minimum Qualifications

• High School Diploma or equivalent.
• Two (2) years Medicare Financial/Overpayment Recovery experience with proficiency in all overpayment recovery areas, or applicable adjustment experience in other WPS contracts.
• Demonstrated knowledge of Overpayment Recovery Regulations, including coordination of benefits, financial cash receipts/recovery regulations and procedures, HIGLAS system, claims processing guidelines, edit resolution, and online systems.
• Knowledge of how to interpret regulations and apply them to process manuals, work instructions, and departmental guidelines.
• Knowledge of internal/external audit procedures, quality review standards, and audit documentation requirements.
• In-depth knowledge of insurance, payment recovery, reimbursement processes, and overpayment case workflow.
• Strong written and verbal communication skills for mentoring staff, preparing reports, and documenting procedures.
• Skilled in researching and resolving complex financial or recovery-related case situations with sound judgment.
• Ability to train new employees, provide ongoing coaching, and support team development.
• Ability to collaborate effectively in internal and external audit activities and support cross-functional teams.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber internet.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net).
• Please review Remote Worker FAQs for additional information.

Benefits

• Bargaining Unit position
• Remote work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are

WPS, a health solutions company, is a leading not‑for‑profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active‑day and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

Medicare (GHA)

This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.