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Senior Health Policy Advisor - Medicare Supplement Claims (Hiring Immediately)

USAA

Phoenix, AZ
1 month ago
$164,780 - $314,960

This Job Position Has Expired

This job listing is no longer available for applications. The position may have been filled or the posting period has ended.

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