Senior Health Policy Advisor - Medicare Supplement Claims (Hiring Immediately)
USAA
Phoenix, AZ
1 month ago
$164,780 - $314,960
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Job Description
Join USAA as a Senior Health Policy Advisor, where you'll leverage your medical expertise to guide Medicare Supplement claims and combat fraud. This role involves reviewing complex medical cases and collaborating with investigators to ensure compliance and accuracy in claims processing.
Key Responsibilities
Advise on morbidity and claims risk of health policies
Support investigators on medical procedures and coding issues
Review complicated medical histories for claims payment accuracy
Conduct research on medical advancements and public health trends
Train claim and special investigation unit investigators
Collaborate with senior leaders to establish claims and fraud guidelines
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
Demonstrated strategy development and thought leadership in the medical field
Preferred Qualifications
US military experience
4 years working with Medicare Supplement claims
Ability to conduct complex healthcare fraud investigation reviews
Experience with Medicare state and federal regulations
Exceptional ability to summarize and analyze medical records
Benefits & Perks
Comprehensive medical, dental and vision plans401(k) and pensionLife insuranceParental benefits and adoption assistancePaid time off with paid holidays plus 16 paid volunteer hoursVarious wellness programs