Stop Loss Claims Analyst bei Berkley Accident & Health
Berkley Accident & Health · Hamilton Square, Vereinigte Staaten Von Amerika · Hybrid
- Professional
- Optionales Büro in Hamilton Square
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.
This position can either be fully remote (if not within commutable distance to the office) or based in our Hamilton Square, NJ office which offers a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.
#LI-AV1 #LI-Remote
The company is an equal employment opportunity employer.
Responsibilities:As a Stop Loss 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.
What you can expect:
- Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent
- Internal mobility opportunities
- Visibility to senior leaders and partnership with cross functional teams
- Opportunity to impact change
- Benefits – 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 education
We'll count on you to:
- Process an average of 5 to 7 claims per day
- Maintain a processing accuracy of 99% or better
- Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
- Review and adjudicate claims within approved authority limits
- Maintain assigned claim block and assist other team members while meeting departmental guidelines
- Document 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 appropriate
- Other duties as assigned
What you need to have:
- 3-5+ years stop loss claims experience
- Prior experience handling first dollar payer insurance (medical healthcare claims)
- Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing
- Ability to use mathematics to adjudicate claims
- Detail oriented with a high degree of accuracy and ability to multitask
- Strong problem solving, decision-making, reporting and analytical skills
- Must possess good judgment and work effectively with internal business areas, peers and co-workers
- Demonstrated proficiency in Microsoft Office software
What 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 deadlines
Ability to accept changing priorities with a minimum of disruption
BAH - Stop Loss Claims Analyst
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