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Claims Compliance Representative

Employer
Merchants Insurance Group
Location
Buffalo, New York
Salary
Competitive pay scale and outstanding company bonus
Closing date
Oct 3, 2022

View more

Category
Claims
Job Type
Full Time
Career Level
Experienced (Non-Manager)

Job Details

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

Merchants Insurance Group is proud to be named a “Fast Track” company and Top Private Company for the 3rd year in a row by Buffalo’s Business First, a Super Regional Property/Casualty Insurer by the Insurance Journal and has recently been named as one of Ward's top 50 performing insurance companies in the United States for the 2nd year in a row.  Ward's is the provider of benchmarking and best practices for the insurance industry.  They analyze staff levels, compensation, business practices and expenses for all areas of company operations.

The well-being of our colleagues, both current and future, is Merchants Insurance Group’s highest priority. At this time, our colleagues are working a Hybrid work schedule. The Hybrid work schedule requires 8 full days per month in the office, with the option to work the remaining days per month at home or in the office. This exciting new Hybrid Work benefit will offer colleagues a flexible work schedule with the ability to remain connected with your Merchants team and colleagues.

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 injury claim handling experience.
  • Prior familiarity with the Medicare Secondary Payer Act, Conditional Payment Claims, and MMSEA Section 111 is a plus or training will be provided.
  • Prior Legal Billing, Auditing, and Medicare Compliance knowledge is a plus
  • Professional designations or working towards industry specific designations are a plus. 
  • Exceptional organization, attention to detail, negotiation and communication skills.
  • Microsoft Office experience. 

Merchants Insurance Group Benefits:

  • Welcoming and positive work environment
  • Flexible work arrangements, including flex scheduling and summer hours
  • Hybrid work schedule. The Hybrid work schedule will require 8 full days per month in the office, with the option to work the remaining days per month at home or in the office.
  • 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.
  • Outstanding company bonus programs
  • Tuition Reimbursement

And many more exciting company benefits!! EOE

Company

Since 1918, Merchants Insurance Group has been providing high-quality property and casualty insurance for businesses and individuals throughout the Northeast and North Central United States.

Rated “A-” by the A.M. Best company, Merchants Insurance Group is headquartered in Buffalo, New York and operates regional offices in Buffalo and Hauppauge, New York; Manchester, New Hampshire; and Mount Laurel, New Jersey.  Merchants Insurance Group is proud to be named a “Fast Track” company and Top Private Company for the 3rd year in a row by Buffalo’s Business First, a Super Regional Property/Casualty Insurer by the Insurance Journal and has recently been named as one of Ward's top 50 performing insurance companies in the United States for the second year in a row.  Ward's is the provider of benchmarking and best practices for the insurance industry.  They analyze staff levels, compensation, business practices and expenses for all areas of company operations.

Merchants writes predominantly commercial insurance in market segments with identifiable risk characteristics, concentrating on artisan contractors, business owners and commercial automobile.

Our products are sold through a network of more than 1,000 independent insurance agents. We sell our products through independent agents because we believe they provide value to policyholders through their broad range of products and their insurance expertise.

Outstanding service, competitive rates, personalized attention and a large offering of products make Merchants Insurance Group unique.  Our focused, low-risk approach to property and casualty insurance has proven successful for almost 100 years.  All of our colleagues work to help our agents and protect our customers, gain their trust and earn their business…every day.

 

Company info
Website
Telephone
7168493161
Location
250 Main Street
Bufffalo
NY
14203
US

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