Senior Stop Loss Claims Analyst - Remote/Hybrid

Berkley Small Business Solutions (a Berkley Company); Hamilton Township (NJ); Hybrid; USD 80,000 - 90,000; Full time

Benefits offered by this job

Health benefits

Paid time off

401(k) retirement plan

Profit sharing

Health savings account

Tuition assistance

Job summary

Berkley Accident and Health is seeking a Senior Stop Loss Claims Analyst to join a top-tier claims team. This role focuses on auditing complex stop loss claims, applying contract language, and making accurate reimbursement decisions.

The position supports a hybrid schedule with four days in the office and one day remote, with opportunities for mentorship and cross-functional collaboration. You will review high-severity claims, ensure regulatory compliance, and partner with stakeholders to

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.

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.
• Resolve claim discrepancies, reconciliation issues, and complex problem cases.
• 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

Contract interpretation

Analytical skills

Excel

Communication

Prioritization

Regulatory compliance

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 top-tier claims team. This role focuses on auditing complex stop loss claims, applying contract language, and making accurate reimbursement decisions.

The position supports a hybrid schedule with four days in the office and one day remote, with opportunities for mentorship and cross-functional collaboration. You will review high-severity claims, ensure regulatory compliance, and partner with stakeholders to