Assistant General Counsel Medicare Secondary Payer REMOTE, AF Group
AF Group

Minneapolis, Minnesota

This job has expired.


Under the direction of the General Counsel, this position will serve in an advisory capacity to the Enterprise and business units. Conducts research where necessary, examine records, conducts investigations, attends depositions, consult with witnesses, insured(s), legal assistants, and/or personnel. Participate in negotiations on behalf of the Company including settlements. In addition, this position will provide leadership and expertise on major company projects as necessary.

Medicare Focus: Act as company resource for all aspects of Medicare's involvement in workers compensation settlements. Prepare Medicare set aside (MSA) documents including anticipated medical expenses and life expectancy. Determine and coordinate submissions to Center of Medicare/Medicaid Services (CMS) when necessary. Evaluate claims to reduce future MSA costs.

RESPONSIBILITIES/TASKS (core for all):

  • Responsible for applying legal principles, knowledge and skills based on experience.
  • Evaluates and selects appropriate legal techniques, procedures and criteria using judgment in solving legal issues.
  • Drafts and/or dictates legal correspondence and memorandums and works with minimal supervision on all assigned matters.
  • Conducts legal research and offers timely legal opinions and advice upon reasonable demand.
  • Provides objective assessment of risk areas.
  • Works on special projects as assigned.
Additional Medicare Focus Responsibilities:
  • Perform legal research on all aspects of Medicare interaction with Workers Compensation.
  • Lead Enterprise in development and implementation of Claims processes involving Medicare.
  • Directs Counsel in proper application of Medicare law.
  • Evaluate the quality of MSAs prepared internally and externally.
  • Draft and submit conditional payment disputes, as appropriate.
  • Assist with settlement language pertaining to Medicare exposure.
  • Participate in claim settlement authority discussions at all levels, directing the Medicare compliance in the settlement
Additional Responsibilities/Tasks of Assistant General Counsel II (core for all):
  • Responsible for handling complex assigned legal projects requiring originality and ingenuity.
  • Possesses a broad knowledge of principles, practices, and procedures to the completion of difficult assignments.
  • Serves in an advisory capacity, making recommendations which may have an important bearing on the conduct of the organizational business including risk assessment, identifying possible outcomes and assessing the probability of any of those outcomes.
  • Identifies risks and designs and/or implements controls to mitigate those risks.
  • Research, plan, organize and conduct programs, seminars, conferences and/or presentations for clients and company personnel to educate on legal matters.
  • Actively participates in company and community events.
  • Requires high degree of independent and creative judgment.
Additional Medicare Focus Responsibilities:
  • Analyzes significant or unique Medicare exposures to ensure compliance with appropriate laws, regulations, corporate policies and business unit procedure.
  • Develops multi-state expertise in varying Medicare exposure due to state workers' compensation law differences.
  • Works with State Workers' Compensation approving bodies on appropriate Medicare compliance policies that are compatible with our business goals and objectives to protect Medicare's interests.
  • Analyzes new law, regulation and administrative trends for potential impact on business goals and objectives.
  • Represent the Enterprise on Medicare issues to governmental agencies, industry groups, and attorney organizations.
  • Pursue conditional payment disputes and represent the corporation at the highest level of appeal.
Additional Responsibilities/Tasks of Assistant General Counsel III (core for all):
  • Possess and applies an advanced comprehensive knowledge of principles, practices and procedures to the completion of complex assignments.
  • Operates with substantial latitude for action and/or decision.
  • Provides leadership on major projects and may provide work direction and training to other attorneys.
  • Conducts broad legal assignments, necessitating ability to evaluate matters which may have a major bearing on the conduct of the Company's business.
  • Assists with the review and evaluation of personnel performance.
  • Act as senior program or project manger.
  • Mentor less-experienced professionals.
  • Acts as a back-up in absence of Manager.
Additional Medicare Focus Responsibilities:
  • Establishes highest-level Medicare compliance strategy and recommends implementation of strategic opportunities with significant impact to the corporation.
  • Participates in development of business alliance, partnering, acquisitions or divestitures relevant to Medicare compliance strategies.
  • Provides guidance to cross-functional team members.
  • Understands the business case and has an appreciation of financial/analytical issues and profit and loss implications.
  • Works collaboratively with senior management to identify high risk Medicare exposure and to develop policies, procedure and training, as needed.
  • Respond to alleged compliance exposure with the initiation of investigative procedures and develops and implements a process to resolve and reduce future exposures.
  • Involved in directing the defense of any Medicare-related litigation.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

A Juris Doctor Degree and admission to the bar (in good standing) in employed state(s) required. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

Additional Medicare Focus Education:

Certification in MSA preparation required within one year of starting job.

EXPERIENCE:

A minimum of two (2) years of experience in the insurance industry and one year of legal, compliance and/or regulatory experience.

Additional Experience Required for Assistant General Counsel II:

A minimum of four (4) years of legal experience, with two years of experience in the insurance industry preferred.

Additional Experience Required for Assistant General Counsel III:

Minimum of six (6) years of legal experience, with four (4) years of experience in the insurance industry.

Additional Medicare Focus Experience:

Experience in evaluating and completing MSAs.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
  • Knowledge of federal and state laws and regulations governing insurance.
  • Ability to understand complex legal issues.
  • Excellent analytical and communication skills; ability to interface with legal counsel and business groups at all levels of the organization.
  • Effective leadership, management and advocacy skills.
  • Strong problem solver; excellent project management skills; attention to detail.
  • Skilled in development of policies, procedures, training methods and materials.
  • Basic to working knowledge of corporate policies and procedures.
  • Basic to working knowledge of contracting concepts and Uniform Commercial Code.
  • Ability to draft and review simple contractual instruments
  • Ability to read, analyze and interpret statutes, general business and legal periodicals, professional journals, technical procedures and governmental regulations.
  • Highly developed sense of ethics and integrity.
Additional SKA Required for Assistant General Counsel II
  • In-depth knowledge of federal and state laws and regulations governing the enterprise.
  • Ability to work independently as well as in a team environment.
  • Illustrates sound judgment and has the ability to encourage others to use professional judgment.
  • Ability to develop optimistic and collaborative relationships both internally and externally.
  • Possesses understanding of the business and has an appreciation of financial/analytical issues and profit and loss implications.
  • Significant ability to influence senior corporate management.
  • Ability to perform in complex cross-functional business environment.
  • Must be able to develop rapport with client and to engender confidence with the client and in their own professional competence and judgment.
  • Excellent presentation, teambuilding and leadership skills.
  • Good analytical, negotiation, organizational, presentation, verbal and written communication skills.
  • Qualified to effectively present information and respond to questions from courts, regulators, clients, customers and the general public.
Additional SKA Required for Assistant General Counsel III
  • Extensive knowledge of federal and state laws and regulations governing the Enterprise.
  • Extensive knowledge of insurance industry and financial acumen.
  • Demonstrated ability to effectively represent corporate, legislative, and regulatory interests in a variety of situations.
  • Ability to provide functional advice to other attorneys and clients on complicated matters.
  • Advanced contract and technical knowledge, and/or experience in international contracting, joint venture formation, strategic partnering, or other highly complex contractual arrangements.
  • Projects outcomes/costs and benefits of applying legal and administrative resources and is responsible for achieving planned outcomes and targeted return on invested resources.
  • Ability to mentor and coach team members.
  • Strong leadership skills.
WORKING CONDITIONS:

Work is mostly performed in an office setting with no unusual hazards. Travel is required. Must be able to drive an automobile and have valid operator license. Specific vision abilities required by this job includes close vision, distance vision, color vision, and ability to adjust focus. While performing the duties of this job, the employee is frequently required to handle documents, books, manuals; reach with hands and arms; talk; and hear.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.


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