Claims Analyst

Stop Loss Claims AuditorBerkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.As a Stop Loss Claims Auditor (a.k.a. "Claims Analyst"), you'll perform quality review and evaluation of all claim submissions received and logged into our claims system to determine whether the amount requested is eligible for reimbursement.This position can either be fully remote (if not within commutable distance to the office) or based in one of our offices:Hamilton Square, NJWest Hartford, CTMarlborough, MAHarleysville, PAWe offer hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.What you can expect:Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talentInternal mobility opportunitiesVisibility to senior leaders and partnership with cross functional teamsOpportunity to impact changeBenefits – competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing educationWe'll count on you to:Process an average of 5 to 7 claims per dayMaintain a processing accuracy of 99% or betterDetermine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claimReview and adjudicate claims within approved authority limitsMaintain assigned claim block and assist other team members while meeting departmental guidelinesDocument rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.Elevate issues to next level of supervision, as appropriateOther duties as assignedWhat you need to have:3-5+ years stop loss claims experiencePrior experience handling first dollar payer insurance (medical healthcare claims)Experience with medical billing practices, CPT codes, revenue codes, and/or universal billingAbility to use mathematics to adjudicate claimsDetail oriented with a high degree of accuracy and ability to multitaskStrong problem solving, decision-making, reporting and analytical skillsMust possess good judgment and work effectively with internal business areas, peers and co-workersDemonstrated proficiency in Microsoft Office softwareWhat makes you stand out:Prior experience handling stop loss claims at the reinsurance level (medical healthcare claims)Ability to work independently, prioritize, organize and assign own work to meet deadlinesAbility to accept changing priorities with a minimum of disruptionWe do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including: Base Salary Range: $70,000 - $80,000. Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and generous profit-sharing plan. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.Sponsorship not Offered for this Role