Medicare Compliance Claim Analyst - Michigan

Job Type:

Dearborn, Michigan

Monday-Friday 8am-5:30pm ET

The Auto Club Group is looking for a detail-oriented and analytical Michigan Medicare Compliance Claims Analyst to play a vital role in ensuring accurate, compliant, and cost-effective medical claims processing. In this dynamic position, you'll leverage web-based technology and specialized applications to review, analyze, document, and manage medical claims while helping deliver exceptional service to members, providers, and internal stakeholders.

As a trusted subject matter expert, you'll investigate and evaluate medical billing charges, ensuring treatments and services aligning with claim-related injuries and Medicare compliance requirements. You'll analyze medical records, explanation of benefits (EOBs), loss reports, and other documentation to make informed payment decisions and identify opportunities to prevent duplicate or inappropriate payments.

This role offers extensive collaboration, as you'll partner with claim representatives, medical professionals, healthcare providers, and customers to resolve billing inquiries, explain payment determinations, verify coverage, coordinate benefits, and ensure proper billing practices. You'll also serve as a key liaison, helping drive positive outcomes through research, problem-solving, and effective communication.

Additionally, you'll monitor claim expenditures, approve reasonable and customary payments in accordance with corporate guidelines, support recovery efforts when appropriate, and may represent the organization during depositions, settlement hearings, and other legal proceedings.

If you thrive in a fast-paced environment where analytical thinking, compliance expertise, and customer advocacy come together, this is an exciting opportunity to make a meaningful impact while contributing to the financial integrity and service excellence of The Auto Club Group.

• Review claim information to determine if ACG has an exposure of ORM. 
• Process Medicare Advantage requests for reimbursement. 
• Identify proper data if claim qualifies for reporting, if not remove from reporting. 
• Report on appropriate claims.
• Determine validity of CMS liens. 
• For all Medical related areas: Act as a liaison between the customer, and providers in order to: research payment status, explain payment amounts approved, resolve lower-level reconsiderations, verify coverage, explain coordination of benefits pre-authorization and correct billing procedures to providers, etc.  
• Assist in the recovery of medical expenditures from the insured, medical providers, etc. in accordance with established procedures if applicable. 

Required

Education (including minimum education and any licensing/certifications):

• College level coursework in Business Administration, Insurance, Management, or a related field.
• A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.

Experience:

• claim analysis, or similar function

• medical bill review (cost containment) operating a personal computer
• utilizing software packages (e.g. Word, Excel, Access, Power Point, VISIO, etc.)

Knowledge and Skills:

Knowledge of one or more of the following:

• medical terminology and human anatomy
• CPT, ICD-9 and 10 and revenue codes (MBRU)
• Property and casualty claim process and procedures
• FACTS, IPM and CPS’

Ability to:

• Use automated processing systems
• effectively respond to questions/concerns
• communicate effectively with others in a work environment, with the Public and vendors
• independently perform detailed, complex medical bill or similar analysis

Demonstrated skill in:

• organization and planning
• analyzing and problem solving
• written communications to include record keeping and report preparation
• decision making
• negotiating

Preferred

Education:

• Associate's degree in Business Administration, Insurance or a related field.

Experience:

• Processing or working within a medical claims environment
• Medical billing experience with both Medicare and Medicaid
• Exposure to processing or working with VA (Veteran Affairs) claims
• Working within a heavy team environment
• Performing both inbound and outbound calling to internal and external clients

The ability to:

• Communicate proficiently both orally and written
• Remain organized and work on multiple tasks simultaneously and efficiently
• Work independently on a remote basis and be self-sufficient within a professional setting

• This is a hybrid work arrangement (time spent in office and remote). Depending on the employee's role and leadership's assessment, some employees will come into an ACG facility on a weekly basis, a monthly basis, or on an "as needed" basis for key meetings and collaborative activities. Most employees will be required to come into the office, at a minimum, for important departmental meetings or teambuilding events

• For this opening, employees will perform daily work duties on a remote basis with any needed in office visits outlined by management. This position will be required to report in office as outlined by the management team at minimum for team meetings and specific assignments. Candidates must reside within the state of Michigan for hybrid purposes.

This position is expected to remain posted through August 12, 2026; however, it may close at any time once a qualified candidate pool is identified.

Who We Are

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life’s journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you’ll notice is that same, whole-hearted, enthusiastic advocacy for each other.

We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

To learn more about AAA The Auto Club Group visit www.aaa.com

Important Note:

ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.  

The above statements describe the principal and essential functions, but not all functions that may be inherent in the job.  This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements.  Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.

The Auto Club Group, and all its affiliated companies, is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Regular and reliable attendance is essential for the function of this job.

AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.