Benefits at WPS Health Solutions

Support ITIL-based infrastructure processes including change control in ServiceNow, attend Change Advisory Board meetings, update and test documentation, assist disaster recovery planning, and help with major incident and problem management activities while collaborating with cross-functional teams.

Review and adjudicate first‑level Medicare redetermination appeals by comparing claims to audits and policy, reviewing medical documentation, referring clinical cases, drafting MRN letters, resolving coding/payment errors, documenting actions, educating providers, and supporting CMS performance metrics.

Coordinate and monitor individualized care plans for members with complex needs, manage authorizations and transitions of care, educate members and caregivers, document care activities, and liaise among members, families, and providers to ensure quality, cost-effective services.