Claims Examiner III - LPN
Remote · USFull-time$21.78/hrSeen 2w agoSeen in employer's feed 5 days ago
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At a glance
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Requirements
Credentials this posting asks for.
Job overview
The Claims Examiner III LPN protects the Military Veteran Health program by investigating potential fraud, waste, and abuse. The role combines clinical expertise and data analysis to assess medical necessity, identify unusual utilization, and support appropriate benefit administration. It also develops cases, contributes to audits and quality initiatives, and communicates findings to internal leaders and external oversight partners. U.S. citizenship is required because of Department of Defense restrictions.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Job Duties
Description
U.S. citizenship is required for this position due to Department of Defense restrictions.
Our Claims Examiner III LPN protects the integrity of the Military Veteran Health (MVH) program by identifying, investigating, and preventing potential fraud, waste, and abuse. They blend clinical expertise with data analysis to evaluate medical necessity, detect unusual utilization patterns, and ensure benefits are administered appropriately. This Claims Examiner collaborates with internal leadership and external oversight partners through clear communication, thorough case development, and wellsupported recommendations. Contributing to audit activities and quality initiatives, this role helps maintain compliance and strengthens trust in the program.
Additional Information
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Pay rate: At least $21.78/hour - Based on individual experience and county SCA rates.
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Training Location/Schedule: Monday-Friday 8am~4pm
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Scheduled Shift: Flexible schedule once trained, 8-hours continual shift between 7:00am CT ~ 5:00pm CT)
Work Location
We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
How do I know this opportunity is right for me? If you can:
Analyze data from anti-fraud software, statistical reports, and medical records to identify potential fraud, abuse, or aberrant utilization patterns.
Develop and manage investigative cases, including reviewing claims histories, evaluating patterns that exceed norms, and researching allegations of fraud and abuse within the MVH program.
Perform pre-payment and post-payment reviews of claims and medical records to determine medical necessity, appropriateness of care, and compliance with MVH policy.
Compile and prepare data in formats suitable for Physician and PEER Review and create spreadsheets and audit summaries to support findings.
Utilize medical knowledge to identify overutilization trends and irregular claim activity.
Conduct individual audits and assess the significance of data from federal and internal sources to strengthen program controls.
Ability to work in a fast past, high volume claims processing team.
Initiate and compose professional correspondence with beneficiaries, providers, contractors, and external partners to obtain information, educate stakeholders, and refer cases to TMA or law enforcement when necessary.
Minimum Qualifications
U.S. citizenship is required for this position due to Department of Defense restrictions.
Licensed Registered Nurse (RN): Associate Degree in Nursing or equivalent diploma from accredited Nursing Program OR Licensed Practical Nurse (LPN): Accredited Practical Nursing Program Certification
Current RN or LPN licensure.
3 or more years clinical practice experience.
Ability to learn and apply governing MVH regulations, policies, and procedures.
Ability to analyze and document medical findings.
Preferred Qualifications
Strong experience using MS Excel.
Bachelor of Science Degree in Nursing (RN).
5 or more years clinical practice experience with 2 or more years in an acute care setting.
Fluent in a foreign language.
Fraud prevention or medical auditing background.
Core Qualities for Success
Ability to interpret medical records, claims data, and utilization patterns.
Excellent written communication and professional correspondence skills.
Attention to detail and comfort working with large datasets.
Commitment to supporting program integrity and reducing fraud, waste, and abuse.
Remote Work Requirements
Wired (ethernet cable) internet connection from your router to your computer.
High speed cable or fiber
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
Remote work options available
Performance bonus and/or merit increase opportunities
401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
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-duty 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.
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WPS Health Blog
This position supports services under U.S. Department of Defense (DoD) Defense Health Agency (DHA) contract(s). As such, the role is subject to all applicable federal regulations, DoD contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. DoD contractors and their personnel are subject to screening and background investigation 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.
Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.
Minimum Education Required
Associate Degree
Minimum Experience Required
3 - 20 years
Shift
First (Day)
Number of Openings
1
Public Transportation Accessible
Yes
Veterans Encouraged to Apply
No
Physical Required
Yes
Drug Test Required
Yes
Compensation
$11.41 / Hourly
Postal Code
55407
Job Type
Full Time
Place of Work
On-site
Requisition ID
CLAIM006175
Job Benefits
Not specified
How this job compares
Set against the 792 open Claims Examiner jobs on Olive Jobs, counted November 4, 2026.
- Pay
- This posting$21.78/hr
- US median$19–29/hr46 hourly ranges
This rate, $21.78/hr, is 10% below the US median midpoint ($24/hr) — in the middle half of Claims Examiner hourly ranges across the US.
- Openings
- Olive Jobs lists 12 open Claims Examiner jobs in Minnesota and 792 across the US. 17% of them nationwide are listed as remote or flexible.
- Hiring the most across the US
- Sedgwick673 open
- Philadelphia Insurance Companies16 open
- CVS Health12 open
- Experience
- This posting asks for at least 3 years of experience; Claims Examiner postings that state a minimum ask for 5 years at the median (767 postings).
- Education
- This posting asks for an associate degree; 8 of the 792 open Claims Examiner jobs (1%) ask for an associate degree or higher.
Counted across the open, public US postings on Olive Jobs on November 4, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.
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