Berkley

  • Claims Analyst

    Location Name NJ, Hamilton Square
    ID
    2020-3645
    Date Posted
    2 weeks ago(2/10/2020 9:40 AM)
    Company
    Berkley Accident & Health
    Primary Location
    US-NJ-Hamilton Square
    Category
    Claims
  • Company Details

    Berkley_Accident_&_Health_Logo

    Responsibilities

    The Claims Analyst performs a complete quality review and evaluation of all Stop Loss claim submissions received and logged in the David Young Claim System to determine whether the amount requested is eligible for reimbursement under the Stop Loss Policy in force.  Duties and responsibilities 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.
    • Elevates issues to next level of supervision, as appropriate.
    • Exhibit good organizational, oral communication and interpersonal skills while working with internal and external customers.
    • Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.

    Qualifications

    • 3+ years of Stop Loss claims handling experience in the reinsurance industry with a good understanding of our products.
    • Knowledge of regulatory/statutory guidelines including but not limited to, HIPPA, privacy, Affordable Health Care Act
    • 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.
    • Ability to use mathematics to adjudicate claims.
    • Detail oriented with a high degree of accuracy and ability to multitask.
    • Ability to take direction from next level of supervision or above.
    • 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.
    • Demonstrated proficiency in Microsoft Office software, including Microsoft Word and Excel.
    • Ability to work independently, prioritize, organize and assign own work to meet deadlines. 
    • Must exhibit professional behavior at all times while representing or being identified as an employee of Berkley Accident and Health. Health Care Act, etc.

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