Medicare Claims Quality Audit Manager

Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.

At Great American, we value diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best.

Corporate Claims division is developing a Corporate service to manage all aspects of the Medicare Secondary Payer compliance process. The Medicare Claims Quality Audit Supervisor/Manager will oversee the company’s Medicare Section 111 reporting process and claim reimbursement process. This individual must keep up to date on Medicare secondary payer rules and guidance for liability, no fault and workers compensation claims, and be comfortable working in a matrix environment within Corporate Claims and across multiple business units. The candidate will be responsible for building a Medicare reporting team to further enhance our Medicare compliance. The ideal candidate will have a claims background with strong critical thinking and writing skills.

This position is located in Great American’s corporate offices in downtown Cincinnati with hybrid work from home flexibility.

Essential Job Functions and Responsibilities:

• Performs tasks involved with Medicare secondary payer claims reimbursement as necessary, including:
  • Notifies Medicare of beneficiary claims and claim settlements;
  • Conducts conditional payment investigations and communicates payment responsibilities to claim staff;
  • Reviews all Medicare conditional payment notices and demands for compensability;
  • Pays compensable Medicare conditional payment demands;
  • Drafts appeals and reconsiderations; and
  • Acts as liaison between claimants and Medicare on denied treatment
• Drafts and maintains internal Medicare compliance guides and updates
• Develops and conducts Medicare compliance training, as appropriate
• Acts as liaison between claim staff and Medicare vendors to facilitate reporting mass tort claims
• Maintains and manages internal and external systems supporting Medicare Secondary Payer compliance
• Identifies operational and/or potential systemic problems; identifies root causes and ensures that solutions are implemented promptly
• Establishes work procedures and standards for Medicare reporting group; including evaluation of work methods for new procedure implementations
  • Audits claim files and Medicare reports for adherence to Medicare secondary payer reporting rules
  • Coordinates the work activities of the unit
  • Provides technical guidance to staff
  • Ensures that the team meets performance targets
• Responsible for performance and coaching of staff and decisions regarding talent selection, development, and performance management
• Ensures new members of the team receive proper training
• Performs other duties as assigned
• Participate in industry based continued education

Job Profile:

Education: Bachelor’s Degree or equivalent experience. Associate in Claims Program (AIC) preferred

Experience: 3 to 5 years of claims related experience, including 1 to 3 years of leadership experience.

Scope of Job: Typically manages 2 or more reports. Responsible for setting the priorities and day-to-day tasks for the team. May spend a portion of time performing the work of those they supervise. Decision guided by policies and procedures under limited supervision.

Business Unit:

Benefits:

We offer competitive healthcare, retirement, and paid time off benefits for full-time and part-time benefit eligible employees.