Claim Analyst - Medicare Unit

Claim Analyst (Medicare Unit) - The Auto Club Group

What you will do:

The Auto Club Group is seeking aClaim Analyst who can work under normal supervision within our Medicare/Medicaid Unit.

In this position, you will have the opportunity to:

• Review claim information to determine if ACG has an exposure of ORM.
• Process Medicare Advantage requests for reimbursement.
• Identify proper data if the claim qualifies for reporting, if not remove the claim from reporting.
• Report appropriate claims.
• Determine validity of CMS liens for all medical related areas
• Act as a liaison between the internal customer and Medicare Advantage/CMS to; research payment status, explain payment amounts approved, resolve lower-level reconsiderations, verify coverage, explain coordination of benefits pre-authorization and correct billing procedures to internal customers.
• Assist in the recovery of medical expenditures from the insured, medical providers in accordance with established procedures if applicable.

Employees assigned to the Liability, Bodily Injury, Med Pay, MRTS and Non-MI PIP claim units will handle moderately complex claims involving liability disputes, bodily injuries, and generally valued up to $50,000. Answer coverage and policy questions. Handle Med Pay claims in all states, and PIP claims in KY, MN and ND. Apply the correct liability determination, evaluate the damages and arrive at a fair settlement.

Employees assigned to PIP claim unit are responsible for Michigan PIP Fast Track claims involving minor injuries. Claims will include emergency room treatment and release, primary care physician treatment, and injuries requiring very little follow-up care. May handle losses beyond those identified previously. Work with insureds, physicians' offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations.

Employees assigned to a Recovery unit will complete recovery tasks on moderately complex claims for all lines of business. The tasks may not cover the entire lifecycle of a claim but will be an expansion of those aspects related to the financial recovery of funds previously paid on a claim from liable parties or other insurance carriers. Additional responsibilities may include the following: evaluating and presenting proofs to support both liability and damage decisions; applying knowledge of venues, negligence laws and case law associated with recovery for all states to determine handling strategies; participating in the arbitration process as an applicant, respondent-counter applicant and as an arbitrator rendering decisions on cases presented to Arbitration Forums; negotiating, settling and recovering receipts; ensuring that funds recovered are accounted for appropriately and settlements are maximized.

With our powerful brand and thementoring,we offer, you will find your position as aClaim Analystcan lead to a rewarding career at our growing organization.

How you will benefit:

Will earn a competitive salary of $23.72- $28.46 per hourly with annual bonus potential based on performance.

• Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:
  • 401k Match
  • Medical
  • Dental
  • Vision
  • PTO
  • Paid Holidays
  • Tuition Reimbursement