Job Title: Claims Compliance Analyst
Job Summary
We are seeking a detail-oriented Claims Compliance Analyst to ensure Medicare compliance within Property & Casualty (P&C) claims, including Workers’ Compensation and BOP. The ideal candidate will have a strong understanding of Medicare regulations and will work with internal teams and regulatory authorities to ensure compliance with CMS guidelines, Medicare Secondary Payer (MSP) rules, and reporting requirements.
Key Responsibilities
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Ensure P&C claims (e.g., Workers’ Compensation, BOP) comply with Medicare regulations, including MSP and CMS guidelines.
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Monitor and interpret state and federal legislation impacting Medicare compliance for P&C claims.
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Review claims data for accuracy and compliance with Medicare’s Section 111 and ORM reporting requirements.
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Collaborate with Claims, IT, Legal, and Compliance teams to integrate Medicare requirements into workflows.
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Respond to inquiries from regulatory authorities regarding Medicare compliance in P&C claims.
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Maintain records of compliance activities, audits, and corrective actions.
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Stay updated on emerging Medicare regulations related to P&C claims.
Skills & Experience
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Bachelor’s degree required.
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2+ years of insurance claims experience, with a focus on Workers’ Compensation or BOP.
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Strong knowledge of Medicare Secondary Payer (MSP) rules, Section 111, ORM, and TPOC reporting for P&C claims.
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Strong analytical, communication, and project management skills.
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Ability to manage multiple compliance projects and collaborate with cross-functional teams.
