Claims Analyst
Claims Analyst
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Company Details
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 Berkleys success is our nimble approach to risk our ability to quickly understand think through and devise a plan that addresses each clients 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.
Responsibilities
We 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 valuingour 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 limitedto:
- 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
Qualifications
- 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
- Ability to accept changing priorities with a minimum of disruption
- Strong problem solving decision-making reporting and analytical skills
- Must possess good judgment and work effectively with internal business areas peers and co-workers
- Ability to work independently prioritize organize and assign own work to meet deadlines
- Demonstrated proficiency in Microsoft Office software
Additional Company Details
The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
Base Salary Range: $65000 - $75000
Benefits include: Health dental vision dental life disability wellness paid time off 401(k) and profit-sharing plans
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
Job Description
Required Experience:
IC
Employment Type
Unclear
