Texas Farm Bureau Casualty Insurance Company - Waco, TX
posted 8 days ago
Full-time
Waco, TX
Insurance Carriers and Related Activities
About the position
The Claims Compliance Operations Specialist is responsible for ensuring compliance with federally mandated reporting requirements related to claims submissions to The Centers for Medicare & Medicaid (CMS). This role involves reviewing and revising claims in accordance with the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), as well as maintaining ISO listings and supporting the Claims vendor file according to IRS regulations.
Responsibilities
- Complete electronic loss notices for claim reporting.
- Assign new claims to appropriate Claims Representatives and inform claimants of their contact details.
- Open new files in the Electronic Loss Notice system for various claims types.
- Process salvage items and enter recovery amounts into the system.
- Stay updated on CMS/Section 111 guidance and regulations for Mandatory Insurer Reporting.
- Process copies of Field Issued Checks.
- Build monthly reports for various claim categories.
- Send '180-day Letters' and reissue checks as necessary.
- Process out-of-state drafts, pickup drafts, voids, and stop pays.
- Balance checks issued from the Waco home office and small claims daily.
- Answer and direct telephone calls from insureds and other callers, providing efficient service.
- Balance recoveries, stop payments, and salvage payments for regional and district offices.
- Perform other duties as assigned.
Requirements
- High school diploma or equivalent.
- Spanish/English bilingualism preferred.
- Strong problem-solving abilities.
- Willingness to learn and extend skills.
- Strong oral and written communication skills.
- Proficient in Microsoft Office software.
- All Lines Adjuster license from Texas Department of Insurance or ability to obtain it.
