COMPANY DETAILS

What makes Admiral Insurance Group ADMIRABLE.
Since 1974, Admiral Insurance Group has been supporting business innovation and market growth through our wholesale-dedicated excess and surplus (E&S) lines of commercial insurance. We specialize in underwriting difficult-to-place moderate to high-risk commercial businesses that require creative solutions, outside of the box thinking, entrepreneurial spirit and astute business knowledge. As a member of the W. R. Berkley Corporation, a Fortune 500® Company and one of the nation’s premier commercial lines property casualty insurance providers, we have the resources, support and industry data to provide exceptional service and exciting solutions for our clients and partners.
Unlock your insure-ability. Learn more about Careers at Admiral Insurance Group.
See what it’s like to work in Admiral’s Claims department.
The Company is an equal employment opportunity employer.

QUALIFICATIONS

• Associate or Bachelor’s degree preferred.
• Minimum of 5-7 years of administrative or claims-related experience.
• Experience in commercial P&C compliance and regulatory reporting.
• Knowledge of Medicare/CMS statutory compliance, administration and industry and state reporting requirements.
• Ability to assess priorities and manage deadlines effectively.
• Effective communication skills, both verbal and written.
• Strong organizational skills.
• Proficient in Microsoft Office Suite, Claims Management Systems, and Power BI.

The Medicare Specialist is responsible for overseeing and resolving complex compliance matters related to Medicare/CMS statutory requirements, including Section 111 reporting, MSA submissions, and regulatory audits. This role ensures accurate and timely reporting, supports internal and external stakeholders, and contributes to the organization’s compliance excellence.

• Manage Medicare Section 111 reporting and MSA (Medicare Set-Aside) submissions.
• Maintain and update claims compliance guides to reflect evolving state regulations.
• Oversee CMS error correction processes and ensure compliance with reporting standards.
• Provide technical training and support on regulatory and compliance matters.
• Conduct internal compliance audits to assess adherence to Medicare and state regulations.
• Enter and track ICD codes, TPOC/ORM data, and other Medicare-eligible claimant information after payment is made.
• Coordinate rated age requests and manage documentation through CMS processes.
• Analyze Medicare liens for accuracy with CMS to facilitate lien resolutions and prepare MSA submissions according to CMS submission guidelines.
• Perform manual lien searches and resolve discrepancies with CMS.
• Support additional compliance and claims-related projects as assigned.