Medicare Specialist

Description:

As a Medicare Specialist, you will handle first- and third-party injury claims where a Medicare beneficiary has been identified. You will be assigned claims of all levels of complexity, including catastrophic, as well as claims in multiple states. You will be responsible for facilitating proper Medicare reporting and ensuring Section 111 compliance. You will also review Medicare liens and dispute charges on liens that are not associated with the loss.

Your work:

• Validates information on all medical claims received. Ensures there is no missing or incomplete information and keeps meticulous records of claims. Advises customer on Medicare process as it relates to the loss; explains the claim process and collects required information.

• Researches to determine Medicare eligibility for injured parties on claims that are undetermined.

• Coordinates the final Medicare lien with the owning adjuster on third-party claims and supports Medicare portion of claim through litigation if necessary.

• Researches Medicare liens and reviews injury file to ensure treatment on the liens are related to the accident. Files and may resolve disputes with Medicare on treatment not associated with the loss.

• Actively shapes our company culture (e.g., participating in employee resource groups, volunteering, etc.)

• Lives into cultural norms (e.g., willing to have cameras when it matters: helping onboard new team members, building relationships, etc.)

• Fulfills business needs, which may include investing extra time, helping other teams, etc.

Required Experience, Education and Skills

• High School Diploma/GED or equivalent combination or education and experience required.

What would make us excited about you?

• Knowledge of medical terminology and the ability to understand and assess medical documents is strongly preferred.

• Experience handling first-party medical claims is preferred.

• Negotiating skills and the ability to develop effective negotiating strategies.

• Strong analytical, problem-solving, and organizational skills.

• Ability to work independently and function in a team environment.

• Strong decision-making ability.

• A passion for helping customers.

• Basic math and computer skills. The ability to type 30 words per minute is a requirement.

• Proficient oral and written communication skills and good command of the English language.

• Bilingual a plus!

• Shows respect for differences through excellent communication skills with people from an array of backgrounds.