Berkley 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.
The company is an equal employment opportunity employer.
ResponsibilitiesWe have an opportunity for a Stop Loss Claims Analyst to join our Berkley Accident and Health team! You will 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.
We are open with location, including remote options
We have a welcoming culture valuing our employees – we trademarked the phrase Everything Counts, Everyone Matters® to describe the Berkley commitment to our people and how we do business. We believe that every person in the organization is important and every accomplishment makes a difference in our results. Come join us!
Key functions include but are not limited 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 assigned Qualifications 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 multitaskAbility to accept changing priorities with a minimum of disruptionStrong problem solving, decision-making, reporting and analytical skills Must possess good judgment and work effectively with internal business areas, peers and co-workersAbility to work independently, prioritize, organize and assign own work to meet deadlines Demonstrated proficiency in Microsoft Office software Additional Company Details We 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.
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 Details Sponsorship not Offered for this Role Connect With Us! Not ready to apply? Connect with us for general consideration.