At Zurich North America Claims we acknowledge that work-life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected.
The candidate selected for this opportunity should be able to report to [one of] the following North American Claims office[s]: Addison, Atlanta, Schaumburg, Overland Park, Parsippany, and woodland Hills. We will consider other locations for the right person.
Claims Regulatory Operations is looking for an individual contributor with increasing ownership over Medicare reporting processes, issue resolution, and compliance controls.
The Medicare Compliance Specialist owns monitoring and mitigation of Medicare Reporting compliance risks, identifies systemic issues and drives remediation strategies.
The Medicare Compliance Specialist is responsible for ensuring adherence to all applicable Medicare Secondary Payer (MSP) regulations, including Section 111 reporting requirements. This role serves as a subject matter expert, partnering across Claims, Legal, IT, and third-party administrators (TPAs) to ensure accurate reporting, integrity of key data elements required for MSP report, timely issue resolution, and ongoing compliance with CMS guidelines.
This position plays a critical role in mitigating regulatory risk, driving process improvements, and maintaining audit readiness. In addition, this role will:
- Creates/reviews Medicare reports for accuracy, completeness and compliance with Federal requirements.
- Serves as liaison between various functional areas to maintain compliance with applicable regulatory requirements
- Supports quality assurance processes/procedures.
- Business travel, as required
- Extended hours during peak periods, as required
- Regular predictable attendance
- Adhere to hybrid/onsite expectations
Day to Day Responsibilities:
- Serves as the organizational subject matter expert (SME) for MSP and Section 111 reporting.
- Ensure accurate and timely submission of Medicare reporting data to CMS.
- Conduct regular audits and validations of claims data to identify reporting errors, inconsistencies, or gaps.
- Partners with IT to support system enhancements and automation of MSP reporting processes for improvement & automation focus.
- Serve as the primary point of contact for Medicare compliance inquiries, both internally and externally.
- Monitor regulatory updates and assess impacts on organizational processes, systems, and reporting obligations.
- Lead or support remediation efforts for CMS reporting errors, including error code analysis and resolution tracking.
- Develop and maintain documentation, procedures, and controls supporting Medicare compliance processes.
- Support internal and external audits by providing documentation and responding to inquiries.
- Provide training and guidance to internal stakeholders on Medicare compliance requirements and expectations.
Basic Requirements:
- Bachelor’s Degree and 3 or more years of experience in the Compliance, Claims or Legal area
OR
- High School Diploma or Equivalent and 5 or more years of experience in the Compliance, Claims or Legal area
AND
- Knowledge of insurance products, processes and services
- Experience with Microsoft Office
- Project management experience
Preferred Qualifications:
- Strong knowledge of the legal and regulatory environment
- Strong verbal and written communication skills
- Detail oriented
- Experience with claim systems and data reporting tools
- Experience with regulatory reporting, data validation and/or compliance programs.
- Ability to work in a team environment
- Strong research and information management skills
- Intermediate MS Word and Excel skills
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply—your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $54,500.00 - $89,200.00, with short-term incentive bonus eligibility set at 10%.
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.]
Why Zurich?
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment—so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500®.
Join us for a brighter future—for yourself and our customers.
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.
Zurich complies with 18 U.S. Code § 1033.
Please note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.
Location(s): AM - Schaumburg, AM - Addison, AM - Atlanta, AM - Overland Park, AM - Parsippany, AM - Woodland Hills
Remote Working: Hybrid
Schedule: Full Time
Employment Sponsorship Offered: No
Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE #LI-HYBRID