Medical Specialist Principal - Life Company Medical Supplement Health Claims - Impactful Role in a Military-focused Company (Hiring Immediately)
USAA
Colorado Springs, CO
23 days ago
$164,780 - $314,960
Job Description
Join USAA as a Medical Specialist Principal and play a vital role in advising on Medicare Supplement claims. You will leverage your medical expertise to ensure claims accuracy and support investigators in combating fraud and abuse, all while contributing to the well-being of military families.
Key Responsibilities
Advise on morbidity and claims risk for health policies
Conduct medical and coding reviews
Ensure claims payment accuracy according to CMS guidelines
Research medical advancements and fraud trends
Collaborate with senior leaders to establish claims guidelines
Required Qualifications
Bachelor's degree or 14 years of related experience
10 years of progressive health fraud experience
6 years as a Registered Nurse (RN), Nurse Practitioner (NP), or Medical Doctor (MD)
4 years in medical coding and/or Medicare billing practices
Ability to interpret electrocardiograms and stress test tracings
Preferred Qualifications
US military experience
4 years with Medicare Supplement claims
Proficiency in medical coding
Regulatory experience with Medicare state and federal regulations
Ability to conduct complex healthcare fraud investigations
Benefits & Perks
Comprehensive medical, dental, and vision plans401(k) and pensionLife insuranceParental benefits and adoption assistancePaid time off program with holidays and volunteer hours