Claims Analyst

Berkley Accident and Health (a Berkley Company); Midwest (WY); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Claims Analyst to enhance its risk management team. This role involves evaluating claim submissions, ensuring accuracy, and applying contractual provisions to determine eligibility. With a commitment to fostering a welcoming culture, the company values each employee's contributions and offers flexible work options, including remote opportunities. Join a team where your analytical skills and attention to detail will directly impact the success of innovative solutions tailored for clients. This is a fantastic opportunity to grow in a dynamic environment focused on excellence.

Qualifications

• 5+ years of stop loss claims experience required.
• Strong mathematical skills and attention to detail are essential.

Responsibilities

• Process 5 to 7 claims daily with 99% accuracy.
• Review and adjudicate claims based on medical facts.

Skills

Stop Loss Claims Experience

Medical Healthcare Claims

Mathematical Skills

Attention to Detail

Problem-Solving Skills

Analytical Skills

Tools

Microsoft Office

Job description

Join to apply for the Claims Analyst role at Berkley Accident and Health (a Berkley Company)

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 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. Our success lies in our nimble approach to risk—quickly understanding, analyzing, and devising tailored plans for each client, supported by the strength 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.

Responsibilities

We are seeking a Stop Loss Claims Analyst to join our Berkley Accident and Health team! You will perform quality reviews and evaluate all claim submissions logged into our claims system to determine reimbursement eligibility.

Location is flexible, including remote options.

We foster a welcoming culture that values our employees—embodying the phrase "Everything Counts, Everyone Matters," which reflects our commitment to our people and our business principles. We believe every individual and achievement contributes to our success. 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 higher
• Assess claim eligibility promptly by applying contractual provisions to medical facts
• Review and adjudicate claims within authorized limits
• Manage assigned claim blocks and support team members while adhering to departmental guidelines
• Document decision rationale based on contractual provisions, plan details, and medical records
• Escalate issues appropriately
• Perform other duties as assigned

Qualifications

• 5+ years of stop loss claims experience
• Experience with first dollar payer insurance (medical healthcare claims)
• Knowledge of medical billing practices, CPT codes, revenue codes, and universal billing
• Strong mathematical skills for claims adjudication
• High attention to detail, accuracy, and multitasking ability
• Adaptability to changing priorities
• Strong problem-solving, decision-making, reporting, and analytical skills
• Good judgment and effective collaboration with internal and external stakeholders
• Ability to work independently, prioritize, and meet deadlines
• Proficiency in Microsoft Office

Additional Details

We do not accept unsolicited resumes from external recruiting firms.

We offer a competitive salary and benefits package. Salary is determined by role scope, complexity, location, candidate skills, education, experience, and other employment conditions.

Sponsorship

Sponsorship is not offered for this role.

Additional Information

• Senior Level: Mid-Senior level
• Employment Type: Full-time
• Job Function: Finance and Sales
• Industries: Financial Services and Insurance

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