Medicare Compliance Analyst (Claims) jobs in United States
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National Indemnity Company · 2 months ago

Medicare Compliance Analyst (Claims)

National Indemnity Company is actively seeking a Medicare Compliance Analyst to join their Claims Compliance team, supporting Medicare regulatory compliance across multiple property and casualty lines of business. The ideal candidate will ensure compliance with Medicare regulations while managing projects and engaging with state regulatory authorities.

Financial ServicesInsurance

Responsibilities

Ensure compliance with Medicare regulations, including CMS guidelines and HIPAA privacy standards
Monitor and interpret state and federal legislation affecting Medicare claims and reporting
Maintain up-to-date documentation and reference materials related to regulatory requirements
Review and analyze Claims data for accuracy, completeness and compliance for Medicare Section 111 reporting
Identify and resolve discrepancies in claims submissions, including coding
Prepare and submit reports for regulatory filings and internal compliance tracking
Respond to inquiries from state and federal agencies regarding claims and compliance matters
Maintain detailed records of compliance activities, audits, and corrective actions related to Medicare reporting
Work closely with Claims business stakeholders, IT, legal and Compliance to ensure alignment on Medicare compliance initiatives
Support Claims BA teams in integrating compliance requirements into system updates and workflow
Stay informed on emerging regulations and industry best practices
Additional Claims compliance duties as assigned

Qualification

Medicare regulations knowledgeClaims experienceAnalytical skillsMSP rulesProject management skillsResearch skillsCritical thinkingOrganizational skillsCommunication skills

Required

Bachelor's degree required
Ability to assess processes to identify key areas of risk and implement resolution strategies and best practices
Ability to interact with multiple levels of staff and state regulatory authorities
Strong analytical, research, organizational, critical thinking, and project management skills and the ability to apply them in a manner that protects the company's interest while also providing the most amicable solution possible
2+ years of insurance Claims experience in all commercial lines with workers' compensation experience required
Familiarity with Medicare Secondary Payer (MSP) rules, CMS guidelines, including Section 111 reporting
Has a solid understanding of Ongoing Medicare Responsibility for Medicals (ORM) and Total Payment Obligation to claimant (TPOC) reporting requirements

Benefits

Medical (PPO/HDHP), vision, disability, and life insurance.
Enhanced dental plan with orthodontia coverage in addition to a standard plan.
Generous PTO plan for all benefit-time eligible employees.
Paid company holidays and 4 floating holidays.
Paid parental leave.
Employee Retirement Savings Plan/401(k) with company match and immediate vesting.
Education Assistance Program that offers 100% upfront tuition reimbursement after 6 months of service for approved degree programs.
Service Recognition Program that provides a monetary award to be used toward a vacation every 5 years of employment.
Wellness Initiatives that include Fitness Center and Weight Watchers Reimbursement programs.
Voluntary benefits that include accident, critical illness, and hospital indemnity.
Employee discount and rewards program on travel, tickets, electronics, home, and more.

Company

National Indemnity Company

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National Indemnity Company is the lead member of the National Indemnity group of insurance companies. It is a sub-organization of Berkshire Hathaway.

Funding

Current Stage
Late Stage
Company data provided by crunchbase