Medicare Compliance Claim Analyst - Michigan

Location Details Dearborn, Michigan Prescription drug coverage. 401(k) plan to support long-term financial goals. 3% automatic deferral upon eligibility; may contribute 1% to 50% of eligible earnings, either pre or post tax. Company match of 50% paid on employee contributions up to 6% of pay, payable to employees following the end of the year; immediate vesting. Additional company contribution of 4% of pay each pay day into your account; 100% vested after three (3) years of service. Health Savings Account (HSA) and Flexible Spending Accounts (FSA) options. Job Type Full time Exempt/Non Exempt Hourly Job Description Must reside within 50 miles from Dearborn, Michigan Location Details: Dearborn, Michigan Position Schedule / Shift Monday-Friday 8am-5:30pm ET Position Summary The Auto Club Group is looking for a detail-oriented and analytical Michigan Medicare Compliance Claims Analyst to play a vital role in ensuring accurate, compliant, and cost-effective medical claims processing. In this dynamic position, you'll leverage web-based technology and specialized applications to review, analyze, document, and manage medical claims while helping deliver exceptional service to members, providers, and internal stakeholders. As a trusted subject matter expert, you'll investigate and evaluate medical billing charges, ensuring treatments and services aligning with claim-related injuries and Medicare compliance requirements. You'll analyze medical records, explanation of benefits (EOBs), loss reports, and other documentation to make informed payment decisions and identify opportunities to prevent duplicate or inappropriate payments. This role offers extensive collaboration, as you'll partner with claim representatives, medical professionals, healthcare providers, and customers to resolve billing inquiries, explain payment determinations, verify coverage, coordinate benefits, and ensure proper billing practices. You'll also serve as a key liaison, helping drive positive outcomes through research, problem-solving, and effective communication. Additionally, you'll monitor claim expenditures, approve reasonable and customary payments in accordance with corporate guidelines, support recovery efforts when appropriate, and may represent the organization during depositions, settlement hearings, and other legal proceedings. If you thrive in a fast-paced environment where analytical thinking, compliance expertise, and customer advocacy come together, this is an exciting opportunity to make a meaningful impact while contributing to the financial integrity and service excellence of The Auto Club Group. Key Responsibilities 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 on 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. Qualifications Required Education (including Minimum Education And Any Licensing/certifications) College level coursework in Business Administration, Insurance, Management, or a related field. A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members. Experience claim analysis, or similar function medical bill review (cost containment) operating a personal computer utilizing software packages (e.g. Word, Excel, Access, Power Point, VISIO, etc.) Knowledge And Skills Knowledge of one or more of the following: medical terminology and human anatomy CPT, ICD-9 and 10 and revenue codes (MBRU) Property and casualty claim process and procedures FACTS, IPM and CPS’ Ability To Use automated processing systems effectively respond to questions/concerns communicate effectively with others in a work environment, with the Public and vendors independently perform detailed, complex medical bill or similar analysis Demonstrated Skill In organization and planning analyzing and problem solving written communications to include record keeping and report preparation decision making negotiating Preferred Education Associate's degree in Business Administration, Insurance or a related field. Preferred Experience Processing or working within a medical claims environment Medical billing experience with both Medicare and Medicaid Exposure to processing or working with VA (Veteran Affairs) claims Working within a heavy team environment Performing both inbound and outbound calling to internal and external clients The Ability To Communicate proficiently both orally and written Remain organized and work on multiple tasks simultaneously and efficiently Work independently on a remote basis and be self-sufficient within a professional setting Work Environment This is a hybrid work arrangement (time spent in office and remote). Depending on the employee's role and leadership's assessment, some employees will come into an ACG facility on a weekly basis, a monthly basis, or on an \"as needed\" basis for key meetings and collaborative activities. Most employees will be required to come into the office, at a minimum, for important departmental meetings or teambuilding events For this opening, employees will perform daily work duties on a remote basis with any needed in office visits outlined by management. This position will be required to report in office as outlined by the management team at minimum for team meetings and specific assignments. Candidates must reside within the state of Michigan for hybrid purposes. Compensation & Benefits Overview ACG complies with all applicable state and local laws regarding required benefits (including PTO, paid sick leave, etc.). Compensation A Medicare Compliance Claim Analyst earns a competitive salary of $23.72-$29.17 along with the opportunity for an annual company bonus incentive. Benefits At ACG, we offer a comprehensive and flexible benefits package designed to support your health, financial well-being, and professional growth. Health & Wellness Medical plans with multiple coverage options, including HSA eligibility. Prescription drug coverage. Dental and vision benefits. Employee Assistance Program (confidential support services). Financial Protection & Insurance Company-paid basic life insurance. Optional supplemental life insurance and dependent coverage. Short-term and long-term disability coverage. Critical illness, accident, and pet insurance options. Retirement & Savings 401(k) plan to support long-term financial goals. 3% automatic deferral upon eligibility; may contribute 1% to 50% of eligible earnings, either pre or post tax. Company match of 50% paid on employee contributions up to 6% of pay, payable to employees following the end of the year; immediate vesting. Additional company contribution of 4% of pay each pay day into your account; 100% vested after three (3) years of service. Health Savings Account (HSA) and Flexible Spending Accounts (FSA) options. Time Off & Leave Paid Time Off (PTO): Accrual-based, increases with tenure, eligible at 90 days of employment. Full-time new employees will receive up to 12 PTO days annually; accrual based on start date and may include additional PTO based on role and/or state & local requirements. Part-time employee PTO hours are calculated based upon the standard weekly hours the employee is scheduled to work and will accrue at a minimum of 3 hours per month. Paid holidays: Full-time employees are eligible for 10 company-paid holidays annually, in addition to 1 mental health day, 2 floating holidays, and 1 volunteer day. Holidays will vary by business schedules Part-time employees are eligible for 8 company-paid holidays annually, in addition to 1 mental health day and 2 floating holidays. Holidays will vary by business unit schedules. Paid leave programs, including parental, bereavement, jury duty, and military leave. Career Growth & Education Tuition assistance (up to $5,250 annually; 80% covered by ACG). Professional certification support with 100% reimbursement for eligible programs. Opportunities for career development and advancement. Additional Perks Complimentary AAA membership with roadside assistance and travel discounts. Adoption assistance program. Job Posting Period This position is expected to remain posted through August 12, 2026; however, it may close at any time once a qualified candidate pool is identified. Who We Are Become a part of something bigger. The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America. By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance. And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other. We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger. To learn more about AAA The Auto Club Group visit Important Note ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level. The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements. Equal Opportunity Statement The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status. Regular and reliable attendance is essential for the function of this job. AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position. #J-18808-Ljbffr AAA-The Auto Club Group