Claims Compliance Representative

Buffalo, NY

Merchants Insurance Group, is a leading Property and Casualty Insurer in the Northeast, and is looking for an experienced Claims Compliance Representative for our Claims team to join our Corporate Headquarters located in Buffalo, New York.  

The safety of our colleagues, both current and future, is Merchants Insurance Group’s highest priority. At this time, most of our colleagues are working remotely due to the current COVID-19 pandemic. The candidate selected for this position will be trained remotely and must be able to work from home in a designated work area until such time as it is determined that colleagues will return to the office.

The Claims Compliance Representative will become part of a dedicated compliance team focusing on auditing and compliance management. 

Essential Duties and Responsibilities include, but are not limited to: 

• Review legal bill invoices for accuracy and compliance with Defense Counsel Guidelines.
• Collaborate with defense firms to resolve appeal requests.
• Assist with internal and external reviews to ensure compliance with standards of performance and industry regulations.
• Assist with Medicare Secondary Payer compliance and MMSEA Section 111 reporting.
• Responsible for effective management of defense counsel, including maintaining defense firm profiles, conducting periodic file reviews and handling any discrepancies developed in the auditing processes.
• Compliance with internal claim handling and regulatory standards will be ensured through file audit completed by the incumbent with the results reported to Claims Management.
• Cultivating relationships with claims and other internal staff, attorneys and a variety of service providers and experts all while working towards achieving the most optimal outcomes for Merchants and our policyholders.
• Provide a high level of customer service to internal and external partners.

Qualifications & Skills:

• Qualified candidates will have a 4 year degree or equivalent work related experience.
• Three years legal billing or legal bill auditing and/or litigation handling (either claims adjuster or paralegal).
• Prior Legal Billing, Auditing, and Medicare Compliance knowledge is required.
• Professional designations or working towards industry specific designations are a plus. 
• Exceptional organization, negotiation, Microsoft Office, verbal and written communication skills are required. 

Merchants Insurance Group Benefits:

• Welcoming and positive work environment
• Flexible work arrangements, including flex scheduling and summer hours
• Competitive pay scale
• Generous paid time off package
• Full Benefits: Health, Dental, Vision, Life Insurance, Short Term Disability, 401(k) employer match amount is 100% up to 6% of your annual contributions. You are immediately 100% vested in the employer match dollars.
• Two outstanding company bonus programs
• Tuition Reimbursement

And many more exciting company benefits!! Please visit our company website to apply online: www.merchantsgroup.com.  EOE