Netherlands Job Openings
Berkley
Stop Loss Claims Analyst
Township of Hamilton
FULL TIME
September 18, 2024
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 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
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