Medical Specialist Principal - Life Company Medical Supplement Health Claims
USAA
Phoenix, AZ
1 month ago
$164,780 - $314,960
Job Description
Join USAA as a Medical Specialist Principal, where you will be pivotal in advising on Medicare Supplement claims, reviewing medical histories, and ensuring payment accuracy. Leverage your expertise to combat fraud and enhance our claims processes while enjoying a flexible work environment.
Key Responsibilities
Advise on morbidity and claims risk for Medicare Supplement policies
Review complicated medical histories and claims payment accuracy
Provide expert medical consultation on claims and policies
Conduct research on medical advancements related to fraud, waste, and abuse
Guide and train claims investigators
Required Qualifications
Bachelor's degree or 4 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
Minimum of 4 years working with Medicare Supplement claims
Ability to conduct complex healthcare fraud investigations
Exceptional ability to summarize and analyze medical records
Experience with Medicare state and federal regulations
Benefits & Perks
Comprehensive medical, dental, and vision plans401(k) and pensionLife insuranceParental benefitsAdoption assistancePaid time off and paid volunteer hoursCareer path planning and continuing education