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Business Ops Analyst I Medicare & Medicaid Claims

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Job ID: 1006788
Date Posted: Apr 17, 2023
Department ID: MI0615 Claims - Operations
Company: Maguire Insurance Agency Inc

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Job Description

Marketing Statement

Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries.   We have been in operation since 1962 and are nationally recognized as a member of  Ward's Top 50 and rated A++ by A.M.Best.


We are looking for a Business Ops Analyst I – Claims to join our team.


Support Medicare reporting processes, Claims Operations Management team and technical staff.


Reviewing and analyzing claims for Medicare reporting and reconciliation, improving the Medicare reporting process and staying current on Medicare changes that may impact the reporting process.

The analyst will also work with various claims personnel as well as internal and external partners to gather and provide claim data and reports, which shall include:
• Reviewing claims, obtaining PII data and report claims to reporting vendors to determine Medicare eligibility.
• Audit accuracy of data-entry.
• Monitor claim activity of Medicare eligible claimants for updating to Medicare.
• Maintain a diary system for tracking and providing updates.
• Respond to internal and external Medicare and ISO inquires.
• Schedule, analyze and distribute reports and status updates to Claims Operation management.



Minimum 3 years’ of direct dealings with CMS processes.
Current with all CMS regulations.
Bachelor's degree preferred.
Working knowledge of Microsoft Office applications.
Strong analytical skills.
Ability to build and maintain business relationships.
Demonstrate commitment to continuous improvement.
Ability to work independently and take initiative.

•  National Range $53,000-$59,200.
•  Ultimate salary offered will be based on factors such as applicant experience and geographic location.


EEO Statement

Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer.  In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status,  sexual orientation and/or any other status protected by law. 


We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities.  If you enjoy working in a fast paced work environment with growth potential please apply online.

Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at


This position is not able to be performed within the state of Colorado.

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