Claim Analyst - Medical

A career at The Auto Club Group (ACG) can be satisfying, exciting and rewarding. By aligning your professional development with our business objectives, ACG can help you attain your career goals — and make a difference. Get started by choosing the career that’s right for you.

Dearborn, MI

The Auto Club Group

AAA was founded over 100 years ago for the purpose of lobbying for driver and passenger rights, fair laws and safer vehicles — all to better promote the love of the open road and the adventure of driving. Since then, AAA has grown to over 50 million members strong, while providing valuable membership services such as roadside assistance. Additionally, AAA has broadened its horizons to include all types of travel-related services, as well as offer a variety of insurance and financial products and services. Today’s AAA is a national federation comprised of more than 50 individual clubs throughout the United States and Canada. Whether you’re traveling around the world or to the corner grocery store, planning a honeymoon or weekend road trip, learning to drive or in need of a battery boost, the best way to begin your journey is with AAA.

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Competitive Compensation and Benefits Package

Overview: The Auto Club Group (ACG) provides membership, travel, insurance and financial services offerings to approximately 9 million members and customers across 11 states and 2 U.S. territories through the AAA, Meemic and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
Responsibilities: <ul> <li>Use Web Based and other applications to bill, document or analyze work.&nbsp;</li> <li>Refer callers to appropriate individuals for additional information as needed.</li> <li>May represent company at trials, depositions and settlement hearings.</li> <li>Audit medical billing charges to ensure treatment is consistent with claim related injuries.&nbsp;</li> <li>Review medical reports, health insurance explanation of benefits, loss reports, etc. to obtain additional information and ensure appropriateness of treatment/charges.&nbsp;</li> <li>Communicate with claim representatives and/or medical specialists to discuss medical billing practices.&nbsp;</li> <li>Approve reasonable and customary payments in accordance with corporate guidelines and documents payment/rejection information in Mitchell Medical diary to monitor expenditures, ensure coordination of benefits and avoid duplicate payments.&nbsp;</li> <li>Act as a liaison between the customer, and providers in order to: research payment status, explain payment amounts approved, resolve lower level reconsideration, verify coverage, explain coordination of benefits pre-authorization and correct billing procedures to providers, etc.&nbsp;&nbsp;</li> <li>Assist in the recovery of medical expenditures from the insured, medical providers, etc. in accordance with established procedures if applicable.</li> </ul>
Requirements: <p style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Education:</span></u></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">Associate&rsquo;s degree in Business Administration, Insurance or a related field.</span></li> <li><span style="font-weight: 300;">Professional Coder Certification (Medical Billing &amp; Coding)</span></li> <li><span style="font-weight: 300;">Completion of the Insurance Institute of America&rsquo;s: General Insurance Program, &nbsp;Associate in Claims, Associate in Management or equivalent</span></li> <li><span style="font-weight: 300;">CPCU coursework or designation</span></li> </ul> <p style="font-weight: 300;"><span style="font-weight: 300;">&nbsp;<u style="font-weight: 300;">Experience:</u></span></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">Significant medical bill analysis experience</span></li> <li><span style="font-weight: 300;">Medical Billing &amp; Coding application</span></li> </ul> <p style="font-weight: 300;"><strong style="font-weight: 300;"><span style="font-weight: 300;">&nbsp;</span></strong><u style="font-weight: 300;"><span style="font-weight: 300;">Knowledge of:</span></u></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">Negligence Law</span></li> <li><span style="font-weight: 300;">No-Fault Law</span></li> <li><span style="font-weight: 300;">Essential Insurance Act</span></li> <li><span style="font-weight: 300;">Fair Trade Practices Act as they relate to claims</span></li> <li><span style="font-weight: 300;">Auto Insurance Policy contract and coverages</span></li> <li><span style="font-weight: 300;">CPS, FACTS, IPM, Decision Point, WINS/PCMS</span></li> </ul> <p style="font-weight: 300;"><span style="font-weight: 300;">&nbsp;<strong style="font-weight: 300;"><u style="font-weight: 300;">Work Environment:</u></strong></span></p> <p style="font-weight: 300;"><span style="font-weight: 300;">Works in a temperature controlled office environment.&nbsp; Occasional (less than 20% of work time) travel may be required in order to conduct training in various locations.&nbsp;&nbsp;&nbsp;</span></p> <p style="font-weight: 300;"><span style="font-weight: 300;">&nbsp;</span></p> <p style="font-weight: 300;"><strong style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Required Qualifications:</span></u></strong></p> <p style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Education:</span></u></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">College level coursework in Business Administration, Insurance or a related field or the equivalent in related work experience</span></li> </ul> <p style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Experience:</span></u></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">Claim analysis, or similar function</span></li> <li><span style="font-weight: 300;">Medical bill review (cost containment)</span></li> <li><span style="font-weight: 300;">Operating a personal computer</span></li> <li><span style="font-weight: 300;">Utilizing software packages (e.g. Word, Excel, Access, PowerPoint, Visio, etc.)</span></li> </ul> <p style="font-weight: 300;"><span style="font-weight: 300;">&nbsp;</span></p> <p style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Knowledge and Skills:</span></u></p> <p style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Knowledge of one or more of the following:</span></u></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">Medical terminology and human anatomy</span></li> <li><span style="font-weight: 300;">CPT, ICD-10 and revenue codes</span></li> <li><span style="font-weight: 300;">Medical Coding and billing application</span></li> <li><span style="font-weight: 300;">Property and casualty claims process and procedures</span></li> </ul> <p style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Ability to:</span></u></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">Use automated processing systems</span></li> <li><span style="font-weight: 300;">Effectively respond to questions/concerns</span></li> <li><span style="font-weight: 300;">Communicate effectively with others in a work environment, with the public and vendors both orally and in writing</span></li> <li><span style="font-weight: 300;">Independently perform detailed, complex medical bill or similar analysis</span></li> <li><span style="font-weight: 300;">Ability to thrive in a high-paced, paperless working environment</span></li> </ul> <p style="font-weight: 300;"><u style="font-weight: 300;"><span style="font-weight: 300;">Demonstrated skill in:</span></u></p> <ul style="font-weight: 300;"> <li><span style="font-weight: 300;">Organization and planning</span></li> <li><span style="font-weight: 300;">Analyzing and problem solving</span></li> <li><span style="font-weight: 300;">Written communications to include record keeping and report preparation</span></li> <li><span style="font-weight: 300;">Decision making</span></li> <li><span style="font-weight: 300;">Negotiating</span></li> </ul> <p style="font-weight: 300;"><span style="font-weight: 300;">The Auto Club Group offers a competitive compensation and benefits package including a base salary with performance based incentives; medical/dental/vision insurance, 401(k), generous time off, a complimentary AAA Membership and much more!</span></p>