Medicare Specialist – Claims

<ul> <li class="mail-message-MsoListParagraph"><strong>$2000 Sign-On Bonus &ndash; External Hires</strong></li> <li class="mail-message-MsoListParagraph"><strong>Comprehensive Benefits including Pension</strong></li> </ul>

Los Angeles, CA


<h4><strong>AAA is a member service organization affiliated with the national AAA federation.&nbsp; With offices across the U.S., we're united by a common mission and common values of excellent member service.&nbsp; With more than 14,000 employees in 21 states, we provide legendary service to 16 million loyal members.&nbsp;&nbsp;</strong><br /><br /><strong>With a constantly growing membership, we are always welcoming dedicated professionals looking to challenge themselves and build a career within our dynamic organization.&nbsp; You will find that being a part of a very successful team is extremely rewarding.<br /></strong><strong><br />For more information visit our website:&nbsp;<a href="" target="_blank" rel="noopener noreferrer"></a></strong></h4>

keywords: claims,quality assurance,administration,verify,develop,communication,analysis,reporting,knowledge,license,education,technical,organization,claims,communication


Overview: This individual will work in concert with adjusters handling injury claims to ensure compliance with Medicare regulations.<br /><br /><strong>Remarkable benefits:</strong><br />&bull;&nbsp;&nbsp; &nbsp;Health coverage for medical, dental, vision<br />&bull;&nbsp;&nbsp; &nbsp;401(K) saving plan with company match AND Pension<br />&bull;&nbsp;&nbsp; &nbsp;Tuition assistance<br />&bull;&nbsp;&nbsp; &nbsp;PTO for community volunteer programs<br />&bull;&nbsp;&nbsp; &nbsp;Wellness program<br />&bull;&nbsp;&nbsp; &nbsp;Employee discounts
Responsibilities: <ul> <li>Updates ICD codes, confirming beneficiaries, coordinating Medicare forms, and negotiating charges.</li> <li>Develop leads with CMS and Medicare Advantage Plans to determine No-Fault and Liability lien amounts. Completes the appropriate Medicare reports timely to ensure Medicare reporting compliance.</li> <li>Resolves conditional payment and demand disputes with Medicare.</li> <li>Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, and claims process either verbally or in writing in compliance with Medicare guidelines, regulatory, and statutory requirements.</li> <li>Interpret and evaluate Medicare liens for appropriate reimbursement. Coordinate with bodily injury adjuster to ensure proper claim value and repayment of Medicare lien(s).</li> <li>Handle administrative functions, update database production reports, and document and update claim files via company systems, i.e. Guidewire, ISO, CACS, HUON, HOC, etc.</li> <li>Verify and interpret/resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.</li> <li>Updates claims systems upon receipt of confirmation from Medicare of an exposure&rsquo;s beneficiary status, and upon closure of the claim for accurate Medicare reporting.</li> </ul>
Requirements: <strong>Experience/Education/Competencies</strong><br /><br /> <ul> <li>4-yr. College Degree or equivalent combination of education and work experience required.</li> <li>Ability to service claims of low to moderate complexity, as normally acquired through 3-5 years&rsquo; experience.</li> <li>Moderate computer and line of business technical software skills required.</li> <li>General knowledge of negligence and subrogation principles desired.</li> <li>Medical coding and terminology desired.</li> <li>Moderate understanding of Medicare compliance and bodily injury claims required.</li> <li>Advanced organization and planning recognition skills required.</li> <li>Advanced oral and written communication skills required.</li> <li>Advanced interpersonal skills required.</li> <li>Valid driver's license with a level of financial responsibility required by the club and an acceptable motor vehicle record required for field positions.</li> </ul>