Family Savings Plan Claims Analyst

Network Health WI•Menasha, WI

2d•Hybrid

About The Position

The Family Savings Plan (FSP) Claims Analyst is responsible for the 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. This position requires strong collaboration with cross-functional stakeholders across multiple levels of the organization to support strategic objectives, operational efficiencies, and service excellence. The FSP Claims Analyst may also assist with benefit interpretation, in-depth review and analysis of medical and pharmacy claims, and comprehensive claims research to resolve complex issues, discrepancies, or inquiries. Additionally, the individual is expected to effectively communicate findings and recommendations, demonstrate strong analytical and problem-solving abilities, and handle confidential and sensitive information with professionalism and discretion. A commitment to accuracy, productivity, accountability, and customer-focused service is essential in supporting organizational priorities and delivering high-quality claims management outcomes.

Requirements

HS Diploma required
Data entry experience strongly preferred
Medical claims processing experience strongly preferred
Pharmacy claims processing experience strongly preferred
Medical terminology experience preferred

Nice To Haves

associate degree preferred
2+ Years working in the health insurance industry preferred

Responsibilities

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 escalate 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.