Compliance

• The Auto Club Group is seeking prospective Claim Analyst who will use Web Based and other applications to bill, document or analyze work.
• 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.
• For all Medical related areas: 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

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