Stop Loss Claims Analyst

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 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.

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 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 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

• 2+ 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