• Claim Analyst, Managed Care

    Location Name NJ, Hamilton Square
    Date Posted
    2 weeks ago(1/9/2019 2:17 PM)
    Berkley Accident & Health
    Primary Location
    US-NJ-Hamilton Square
  • Company Details

    Berkley Accident and Health (Berkley) 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 (NYSE: WRB) is one of the largest and best managed property/casualty insurers in the United States.


    Job Summary


    Conduct a review of all Managed Care claims processed by our contracted vendor. This role will require communication with that vendor as appropriate, as well as any internal Berkley staff involved in the administration of the Managed Care segment.   


    Job Responsibilities


    • Review claims payment results performed by contracted vendor on all Provider Excess and HMO Reinsurance business and provide policy documentation, disclosure, risk matrixes and DOFRS to them upon request and within approved authority limits. 
    • Communicate with contracted vendor as appropriate and respond to client and broker inquiries, as necessary.
    • Elevates issues to next level of supervision, as appropriate.
    • Manage workload to meet time service standards.
    • Exhibit good organizational, oral communication and interpersonal skills while working with internal and external customers.
    • Document outcome of claim reviews in the shared drive, as appropriate.
    • Utilize knowledge of regulatory/statutory guidelines including but not limited to, HIPPA, privacy, Affordable Care Act, etc., as appropriate.
    • Other duties as assigned.


    Job Qualifications


    • 3+ years of experience in claims HMO Reinsurance and Provider Excess Loss insurance coverages.
    • Excellent organizational, verbal, and written communication as well as interpersonal and relationship building skills with the ability to influence and add value to the organization.
    • Detail oriented with a high degree of accuracy and ability to multitask.
    • Ability to take direction from next level of supervision or above.
    • Strong problem solving, decision-making, reporting and analytical skills.  Must possess good judgment and work effectively with internal business areas, peers and co-workers.
    • Proficient in Microsoft Office software, including Microsoft Word and Excel.
    • Ability to work independently, prioritize, organize and assign own work to meet deadlines, yet work in a team environment. 
    • Must exhibit professional behavior at all times while representing or being identified as an employee of Berkley Accident and Health.


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