Remote Senior Stop-Loss Claims Analyst

Berkley Accident and Health (a Berkley Company); Hamilton Township (NJ); Remote; USD 80,000 - 90,000; Full time

Benefits offered by this job

Competitive compensation

Comprehensive benefits package

Profit sharing / 401(k)

Job summary

Berkley Accident and Health is seeking a Senior Stop Loss Claims Analyst to join a skilled team that analyzes complex medical claims and applies contract language to reimbursements. You will influence claim outcomes and customer experience across a flexible work setup.

You will audit submissions, manage escalated cases, mentor colleagues, and help drive continuous improvement while ensuring HIPAA and privacy compliance. Strong Excel and office skills are required.

Qualifications

• 5+ years of Stop Loss claims, reinsurance claims, or Stop Loss auditing experience
• Strong understanding of Stop Loss contracts, claim reimbursement provisions, and policy interpretation
• Experience evaluating complex medical claims and supporting documentation
• Excellent analytical, problem-solving, and decision-making abilities; strong written and verbal communication skills
• Ability to prioritize workloads and meet deadlines independently
• Proficiency with Microsoft Excel and Microsoft Office applications
• High School Diploma

Responsibilities

• Review and audit Stop Loss claim submissions to determine reimbursement eligibility
• Analyze complex medical claims and apply contract provisions to claim decisions
• Handle high-severity, challenging, and escalated claim situations independently
• Review medical documentation, plan specifications, and contractual language to support claim determinations
• Document claim rationale with accuracy and consistency
• Maintain production and quality standards while managing an assigned claim inventory
• Provide guidance and expertise to internal business partners and claims colleagues
• Mentor and support newer team members
• Help drive best practices and continuous improvement initiatives
• Ensure compliance with HIPAA, ACA, privacy requirements, and other applicable regulations

Skills

Stop Loss claims analysis

Analytical thinking

Decision making

Communication skills

Time management

Mentoring

Education

High School Diploma

Tools

Microsoft Excel

Microsoft Office

Job description

Berkley Accident and Health is seeking a Senior Stop Loss Claims Analyst to join a skilled team that analyzes complex medical claims and applies contract language to reimbursements. You will influence claim outcomes and customer experience across a flexible work setup.

You will audit submissions, manage escalated cases, mentor colleagues, and help drive continuous improvement while ensuring HIPAA and privacy compliance. Strong Excel and office skills are required.