Medicare Claim Administration Specialist (Peoria, IL)

About Us

We’re not like other insurance companies. From our specialty products to our business model, our culture to our results we’re different.

Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn’t just happen.

It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference.

This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose : to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results.

Apply today to make a difference with us.

RLI is a company with a strong, successful background. For decades, our financial track record has been stellar a testament to our culture and validation of our reputation as an excellent underwriting company.

Our insurance subsidiaries are rated A+ Superior by AM Best company and A Strong by Standard & Poor’s. Check out our strong financial track record .

Position Purpose

Generally managed, as a Medicare reporting and compliance specialist for RLI Insurance, your primary responsibility would be to ensure that the organization meets all regulatory requirements related to Medicare and accurately and timely report claim details to Medicare.

Provide training and educational resources to claim staff to ensure that employees understand their roles and responsibilities in maintaining compliance with regulatory requirements.

Principal Duties & Responsibilities

Follow Medicare compliance programs, policies, and procedures to ensure adherence to applicable laws and regulations.

Stay informed about changes to Medicare regulations, guidelines, and policies, and communicate updates to relevant stakeholders within the organization.

Collaborate with internal departments, including legal, claims processing, and provider relations, to ensure alignment with Medicare compliance standards.

Be a contact for internal staff about Medicare compliance inquiries.

Send out Medicare correspondence letters to external parties.

Assist in developing, administering, and tracking completion of required Medicare trainings.

Maintain accurate documentation of compliance efforts, including audit findings, corrective actions, and training records, to demonstrate compliance with Medicare regulations.

Education & Experience

Typically requires a Associates degree in business administration, insurance, or a related field

2-4 years of related experience

OR equivalent level of education and experience

Knowledge, Skills, & Competencies

Knowledge of CMS reporting and lien requirement.

Ability to use analytical methods in claim processes to find workable solutions.

Excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.

Personal & Professional Growth

RLI encourages its employees to pursue professional development work in insurance and job-related areas. We make a commitment to employees to provide educational opportunities that help them enhance their skills and further their career advancement.

RLI fosters a true learning culture and encourages professional growth through insurance courses, in-house training and other educational programs.

RLI covers the cost for most programs and employees typically earn a bonus upon successful completion of approved courses and certifications.

Our personal and professional growth benefits include :

Nationwide employment opportunities

Training & certification opportunities

Tuition reimbursement

Education bonuses

Diversity & Inclusion

Our goal is to attract, develop and retain the best employee talent from diverse backgrounds while promoting an environment where all viewpoints are valued and individuals feel respected, are treated fairly, and have an opportunity to excel in their chosen careers.

We actively support, and participate in, initiatives led by the American Property Casualty Insurance Association that aim to increase diversity in the insurance industry.

Cultivating an exceptional and diverse workforce to deliver excellent customer service reinforces our culture and is a key to achieving superior business results.

RLI is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.

Total Rewards

At RLI, we're all owners. We hire the best and the brightest employees and allow them to share in the company's success through our Total Rewards.

With the Employee Stock Ownership plan at its core, the Total Rewards program includes all compensation, benefits and perks that come with being an RLI employee.

Financial Incentives

Employee stock ownership plan (ESOP)

401(k) automatic 3% company contribution

Annual discretionary 401k and ESOP profit-sharing contribution (up to 15% of base salary)

Annual bonus plans

Work & Life

Paid time off (PTO) and holidays

Paid volunteer time off (VTO) to support our communities

Parental and family care leave

Flexible & hybrid work arrangements

Fitness center discounts and free virtual fitness platform

Employee assistance program

Health & Wellness

Comprehensive medical, dental and vision benefits

Flexible spending and health savings accounts

2x Base Salary for Group Life and AD&D insurance

Voluntary life insurance for purchase

Critical Illness & Accident insurance

Short-term and long-term disability benefits