Job Information
Ohio Farmers Insurance Company Medicare Claims Compliance Senior Representative in Seville, Ohio
The Medicare Claims Compliance Senior Representative works within significant limits and authority on claim assignments of higher technical complexity and coordination. Member of the Medicare Compliance Unit who develops and maintains a thorough and working knowledge of Medicare Section 111 Reporting and Medicare as Secondary Payer requirements, as well as ISO reporting process pertaining to Medicare. Provides day-to-day, claim-specific support to claims professionals on Medicare Compliance. Identifies and escalates reporting errors including defects/trends. Opens cases with Medicare under guidance from Medicare Specialists. Assists in regulatory mandated Medicare reporting. #LI-DNI Develops and maintains a thorough and working knowledge of Medicare Section 111 Reporting and Medicare as Secondary Payer requirements, as well as ISO reporting process pertaining to Medicare. Participates in process improvement initiatives to streamline claims processing operations, improve efficiency, and reduce compliance-related risks, and prepares requests for documentation and authorizations. Provides day-to-day, claim-specific support to claims professionals on Medicare Compliance. Identifies, analyzes, and corrects reporting errors including defects/trends. Coordinates services with Medicare service vendor and claims professional. Opens cases with Medicare as needed. Completes all regulatory mandated Medicare reporting. Reviews to determine a need for Medicare conditional payments disputes and escalates to Medicare Compliance Specialist. Performs ad-hoc individual claim file reviews as needed to assist claims professionals with issues related to Medicare compliance. Participates in various internal/external compliance audits. Maintains effective and ongoing communication with claims department staff, internal and external business partners, insureds, claimants, agents, attorneys, other insurance companies, project team members, and vendors. Ensures customer service excellence. Provides excellent service to claims professionals, leaders, project teams, etc. Medicare Secondary Payer Recovery Portal (MSPRP) Access - Assists in filing of regulatory forms to maintain Medicare portal access, reports, etc and utilizes the MSPRP for requesting, viewing, or submitting information. 3-5 years of experience in Claims Compliance or a related field. Bachelor's degree in Business Administration or a related field and/or commensurate work experience. Behavioral Competencies Collaborates Communicates effectively Customer focus Decision quality Nimble learning Founded in 1848, Westfield is a global leader in property and casualty insurance, delivering superior risk insights and innovative solutions to customers through a diverse portfolio of insurance products. Westfield underwrites commercial, personal, surety, and specialty lines of coverage through a network of leading independent agents and brokers in the United States and specialty products through Lloyd's of London Syndicate 1200. As a mutual insurance company with more than 3,000 employees, Westfield has revenues in excess of $4 billion and more than $10 billion in assets. Westfield celebrates diversity and is committed to inclusion. All qualified applicants receive consideration for employment without regard to race, color, sex, religion, national origin, age, sexual orientation, gender identity, disability, or status as a protected veteran.