Medicare Specialist

Under the general supervision of the Actuary, will be responsible for Medicare related reconciliations and analysis.  Other responsibilities as follows: Ensures compliance with all Medicare statues and policies. Reconciliation of Medicare revenue to enrollment, and claims payment. Oversees the reconciliation of plan membership data against CMS files, discrepancy resolution, and Medicare member premium billing and payment process. Reviews premiums, claims, and enrollment reports from CMS or outside vendors to ensure proper accounting on a monthly basis and to ensure all information is updated and correct reimbursements are received. Manages the process for any delinquent member premium payment and necessary refunds. Reviews third party reports for accuracy and compliance with CMS regulations.

Coordinates efforts with various departments and outside entities to ensure that exceptions arising from reconciliations are resolved in a timely manner. POSITION REQUIREMENTS: Bachelor’s degree in Actuarial Science/Statistics/Accounting/Finance preferred or related field from an accredited college or university or two to three years experience and/or training in a position in the health insurance industry; or equivalent combination of education and experience. Two to three years of Medicare related experience with a knowledge of CMS Medicare rules and regulations preferred but not required. Good organizational and time management skills. Proficient in Microsoft office products. Programming and database experience preferred. Excellent communication skills.   APPLICATION PROCEDURE:

Send resume to mpingree@educatorsmutual.com or mail to Mark Pingree, Educators Mutual, 852 East Arrowhead Lane, Murray, UT 84107.