Medicare Compliance Analyst (Claims)

We are actively seeking a Medicare Compliance Analyst to join our Claims Compliance team, supporting Medicare regulatory compliance across multiple property and casualty lines of business. The ideal candidate will bring a strong working knowledge of Medicare regulations as they relate to P&C Claims.

This role requires a proactive and detail-oriented individual who is comfortable managing multiple projects and engaging with state regulatory authorities. The successful candidate will play a key role in ensuring compliance standards are met while contributing to the development and execution of effective compliance strategies.

Job Responsibilities

• Ensure compliance with Medicare regulations, including CMS guidelines and HIPAA privacy standards.
• Monitor and interpret state and federal legislation affecting Medicare claims and reporting.
• Maintain up-to-date documentation and reference materials related to regulatory requirements.
• Review and analyze Claims data for accuracy, completeness and compliance for Medicare Section 111 reporting.
• Identify and resolve discrepancies in claims submissions, including coding.
• Prepare and submit reports for regulatory filings and internal compliance tracking.
• Respond to inquiries from state and federal agencies regarding claims and compliance matters.
• Maintain detailed records of compliance activities, audits, and corrective actions related to Medicare reporting.
• Work closely with Claims business stakeholders, IT, legal and Compliance to ensure alignment on Medicare compliance initiatives.
• Support Claims BA teams in integrating compliance requirements into system updates and workflow
• Stay informed on emerging regulations and industry best practices.
• Additional Claims compliance duties as assigned

Qualifications

• Bachelor’s degree required
• Ability to assess processes to identify key areas of risk and implement resolution strategies and best practices
• Ability to interact with multiple levels of staff and state regulatory authorities
• Strong analytical, research, organizational, critical thinking, and project management skills and the ability to apply them in a manner that protects the company’s interest while also providing the most amicable solution possible.
• 2+ years of insurance Claims experience in all commercial lines with workers’ compensation experience required
• Familiarity with Medicare Secondary Payer (MSP) rules, CMS guidelines, including Section 111 reporting.
• Has a solid understanding of Ongoing Medicare Responsibility for Medicals (ORM) and Total Payment Obligation to claimant (TPOC) reporting requirements.

About Us

biBerk is where commercial insurance buyers can obtain coverage for their businesses from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. (berkshirehathaway.com) is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through biBerk.com will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer.

BHDIC is domiciled in Omaha, Nebraska. BHDIC and the team at biBerk are focused on helping small business owners quickly and easily buy affordable insurance directly from a financially strong insurance company they can trust.

BHDIC is excited to announce our comprehensive benefits package with some new and enhanced features for 2026 that include:

• Medical (PPO/HDHP), vision, disability, and life insurance.
• Enhanced dental plan with orthodontia coverage in addition to a standard plan.
• Generous PTO plan for all benefit-time eligible employees.
• Paid company holidays and 4 floating holidays.
• Paid parental leave.
• Employee Retirement Savings Plan/401(k) with company match and immediate vesting.
• Education Assistance Program that offers 100% upfront tuition reimbursement after 6 months of service for approved degree programs.
• Service Recognition Program that provides a monetary award to be used toward a vacation every 5 years of employment.
• Wellness Initiatives that include Fitness Center and Weight Watchers Reimbursement programs.
• Voluntary benefits that include accident, critical illness, and hospital indemnity.
• Employee discount and rewards program on travel, tickets, electronics, home, and more.

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The salary range for this position is $70,000-$80,000 per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.

Originally posted on Himalayas