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Medicare Specialist - Claims

Company: Auto Club of Southern California
Location: Diamond Bar
Posted on: November 11, 2021

Job Description:

Medicare Specialist - Claims

$2,000 Sign-on Bonus for External Hires

Work from Home available after initial training period

The individual in this position supports the Auto Claims Operations Unit by providing service pursuant to the policy by handling claims of property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. This individual will work in concert with adjusters handling injury claims to ensure compliance with Medicare regulations.

The primary functions include investigation, evaluation and negotiation of low to moderate complexity claims in compliance with established company technical and customer service Best Practices. Under general technical direction, works within specific limits of authority.

Primary Duties/Responsibilities

  • Updates ICD codes, confirming beneficiaries, coordinating Medicare forms, and negotiating charges.

  • 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.

  • Resolves conditional payment and demand disputes with Medicare.

  • Communicate and interact with a variety of individuals including, attorney’s, insureds and claimants. Explain the Medicare process either verbally or in writing in compliance with Medicare guidelines, regulatory, and statutory requirements.

  • Interpret and evaluate Medicare liens for appropriate reimbursement. Coordinate with bodily injury adjuster to ensure proper claim value and repayment of Medicare lien(s).

  • Handle administrative functions, update database production reports, and document and update claim files via company systems, i.e. Guidewire, ISO, etc.

  • Updates claims systems upon receipt of confirmation from Medicare of an exposure’s beneficiary status, and upon closure of the claim for accurate Medicare reporting.


  • 4-yr. College Degree or equivalent combination of education and work experience required.

  • Ability to service claims of low to moderate complexity, as normally acquired through 3-5 years’ experience.

  • Moderate computer and line of business technical software skills required.

  • General knowledge of negligence and subrogation principles desired.

  • Medical coding and terminology desired.

  • Moderate understanding of Medicare compliance and bodily injury claims required.

  • Advanced organization and planning recognition skills required.

  • Advanced oral and written communication skills required.

  • Advanced interpersonal skills required.

  • Valid driver's license with a level of financial responsibility required by the club and an acceptable motor vehicle record required for field positions.


Remarkable benefits:
•    Health coverage for medical, dental, vision
•    401(K) saving plan with company match AND Pension
•    Tuition assistance
•    PTO for community volunteer programs
•    Wellness program
•    Employee discounts

The Automobile Club of Southern California is part of the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.

Keywords: Auto Club of Southern California, Diamond Bar , Medicare Specialist - Claims, Other , Diamond Bar, California

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