Quality Audit and Training Specialist
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Job Location:
Hamilton Square, NJ - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
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.
This position can either be fully remote (if not within commutable distance to the office) or based in one of our offices:
- Hamilton Square NJ
- West Hartford CT
- Marlborough MA
- Kulpsville PA
We offer 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 youll 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
Well 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
Qualifications
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
Additional Company Details
The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
Base Salary Range: $70000 - $90000
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 Details
Job Description
Required Experience:
IC
Key Skills
- Quality Assurance
- FDA Regulations
- Data Collection
- Food Safety Experience
- ISO 9001
- Mobile Devices
- Root cause Analysis
- Quality Systems
- OSHA
- Food Processing
- Quality Management
- cGMP
About Company
Berkley is a leader in commercial lines insurance, with over 60+ specialized businesses - each with deep expertise in an industry, product, or regional niche.
