Senior Medical Advisor - Life Insurance Health Claims (Hiring Immediately)
USAA
Phoenix, AZ
1 month ago
$164,780 - $314,960
Job Description
Join USAA as a Senior Medical Advisor to lead the Medicare Supplement Claims Department, applying advanced medical expertise and guiding investigators in complex health claims. Enjoy a flexible work environment and an opportunity to make a significant impact in the military community.
Key Responsibilities
Advise on morbidity and claims risk for health policies
Support investigators with medical procedures and coding issues
Review complicated medical histories and testing results
Ensure claims payment accuracy per CMS guidelines
Conduct research on medical advancements and public health trends
Guide claim investigators and advance their medical risk acumen
Collaborate with senior leaders on claims philosophy and guidelines
Participate in special project work involving digital health data
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 of experience in medical coding and/or Medicare billing practices
Ability to interpret electrocardiograms and stress test tracings
Experience collaborating with key resources and stakeholders
Preferred Qualifications
US military experience
Medicare Claims Expertise
Expert Advice on complex medical records
Medical Coding Proficiency
Regulatory Experience with Medicare
Investigation Skills in healthcare fraud
Knowledge of health insurance claims operations
Ability to be deposed during litigation
Benefits & Perks
Comprehensive medical, dental and vision plans401(k) and pensionLife insuranceParental benefits and adoption assistancePaid time off with paid holidays plus volunteer hoursCareer path planning and continuing education