Regulatory Compliance Specialist overseeing compliance for Arc'teryx raw materials and goods. Collaborating across teams to uphold regulatory frameworks and ensure consumer safety with legal standards in focus.
About the role
- Claim Analyst managing Medicare compliance claims for The Auto Club Group in a hybrid work environment. Performing duties related to claim processing and liaison activities with customers and providers.
Responsibilities
- Refer callers to appropriate individuals for additional information as needed.
- May represent company at trials, depositions and settlement hearings.
- Review claim information to determine if ACG has an exposure of ORM.
- Process Medicare Advantage requests for reimbursement.
- Identify proper data if claim qualifies for reporting, if not remove from reporting.
- Report appropriate claims.
- Determine validity of CMS liens.
- Act as a liaison between the customer, and providers in order 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 providers, etc.
- Assist in the recovery of medical expenditures from the insured, medical providers, etc. in accordance with established procedures if applicable
Requirements
- College level coursework in Business Administration, Insurance or a related field or the equivalent in related work experience.
- Claim analysis, or similar function
- Medical bill review (cost containment)
- Operating a personal computer
- Utilizing software packages (e.g. Word, Excel, Access, Power Point, VISIO, etc.)
- Knowledge of one or more of the following: Medical terminology and human anatomy CPT, ICD-9 and 10 and revenue codes (MBRU) Property and casualty claims process and procedures FACTS, IPM and CPS’ ability to: Use automated processing systems Effectively respond to questions/concerns Communicate effectively with others in a work environment, with the Public and vendors Independently perform detailed, complex medical bill or similar analysis Demonstrated skill in: Organization and planning Analyzing and problem solving Written communications to include record keeping and report preparation Decision making Negotiating
Benefits
- Medical, dental and vision benefits
- 401k Match
- Paid parental leave and adoption assistance
- Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
- Paid volunteer day annually
- Tuition assistance program, professional certification reimbursement program and other professional development opportunities
- AAA Membership Discounts, perks, rewards, and much more
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