Family Savings Plan Claims Analyst

Position Overview

The Family Savings Plan (FSP) Claims Analyst is responsible for accurate and timely entry, processing, adjudication, and auditing of medical and pharmacy claims. This role supports end-to-end claims operations and ensures compliance with established policies, procedures, contractual requirements, and regulatory guidelines while contributing to operational excellence and service quality.

Location:

Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model. Travel to the office in Menasha or Brookfield will be required occasionally for the position, including on the first day.

Hours:

1.0 FTE, 40 hours per week, 8 a.m.–5 p.m., Monday through Friday.

• Perform accurate and timely data entry of member- and provider-submitted medical and pharmacy claims.
• Process medical and pharmacy claims in accordance with established policies, procedures, contractual requirements, and regulatory guidelines.
• Audit claims to ensure accuracy in data entry, coding, and payment, identifying and correcting discrepancies as needed.
• Demonstrate behaviors consistent with Network Health's mission, vision, values, and organizational philosophy.
• Respond to internal inquiries regarding claim status, issues, and benefit interpretation within established turnaround times (typically within 24 hours) to meet departmental metrics and contractual standards.
• Proactively follow up with internal departments to resolve outstanding issues or concerns, and appropriately elevate complex or unresolved matters to a Supervisor or designated contact.
• Maintain strong attention to detail, accuracy, and productivity standards while handling sensitive and confidential information.
• Perform additional duties and responsibilities as assigned to support departmental and organizational goals.

• HS Diploma required; associate degree preferred.
• 2+ years working in the health insurance industry preferred.
• Data entry, medical and pharmacy claims processing experience strongly preferred.
• Medical terminology experience preferred.

Network Health is an Equal Opportunity Employer. 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.