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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.
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The Clinical Cost Containment (CCC) RN position affords a seasoned Registered Nurse the ability to use his/her knowledge and experience in a unique and rewarding manner. CCC RNs provide consulting services for internal and external clients and their delegated entities. CCC RNs promote a thorough understanding of current and anticipated clinical needs and expected claims costs while facilitating the use of unique solutions to insure optimal care and claims outcomes. CCC RNs do not interact directly with patients. Our Clinical CCC RNs play in integral role in support of Berkley Accident and Health's vision to be recognized as the industry leader in risk management service. CCC RNs assure optimal clinical outcomes are obtained at a cost commensurate with the level of medical services rendered while also promoting client satisfaction and retention. Duties and responsibilities include but are not limited to:
- Develop and maintain relationships with our Clinical team members, other BAH employees and external clients to further BAH's mission.
- Be responsible for the review of claims, trigger reports, and 50% notice reports to identify catastrophic diagnoses or cases of concern to identify cost savings opportunities.
- Work in conjunction with Claims department to obtain updated/additional clinical or financial information from the client (TPA, Policyholder, Broker).
- Collaborate closely with claims team and underwriters, providing ongoing education to better understand the risk and how to manage it.
- Collaborate with Cost Containment vendors in support of Policyholder optimal outcomes.
- Understand nuances of each line of business and adjust activities and interventions based on the uniqueness of each market segment.
- Serve as subject matter reference in our company’s cost containment programs, including but not limited to our interaction with TPAs, Claims, Sales, Underwriters, Client Representatives, and Brokers.
- Serve as a subject matter reference in analysis of transplant contracts, and provide guidance to the TPA/Case Managers in the selection of the best transplant contract for their client.
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The Manager, Clinical Cost Containment reports to the Director of Health Risk Management and is responsible for the Clinical Cost Containment department. S/he fosters and maintains solid working relationships with both external clients and internal resources via a strong professional network and keeping abreast of new developments affecting case management, health care cost and specialty vendor resources. Our Clinical Cost Containment team plays an integral role in support of Berkley's vision to be recognized as the industry leader in risk management service. This role is responsible for assuring optimal clinical outcomes are obtained at a cost commensurate with the level of medical services rendered while also promoting client satisfaction and retention. Duties and responsibilities include but are not limited to:
- Leads, manages, hires, trains, retains and motivates a team of clinical RNs and para-clinical professionals capable of and committed to providing exceptional service to clients, administrators, vendors and internal BAH resources.
- Responsible for the departmental Clinical Risk and Medical cost management of high dollar claimant treatment(s) throughout the life cycle of the policy. Work with internal as well as external stakeholders to produce an effective clinical and financial outcome.
- Ensures the team operation is efficient and effective with responsibility for departmental oversight of review of claim notices, case management/trigger reports, claims and verbal communications to identify cost savings opportunities.
- Responsible for oversight of departmental clinical research and analytical review.
- Responsible for coaching and developing effective departmental communications regarding claim/financial projections and rationale to both internal/external clients.
- Foster strong relationships with external clients (Policyholders, TPA’s, external CM’s) and internal BAH resources (UW’s, Claims, Account Managers) through individual credibility. Apply business acumen to communicate risk factors, resolve complex inquiries and develop recommendations for continuous improvement and alignment with overall BAH risk strategy
- Provides for oversight of departmental transplant contracts and provide assistance as needed with Policyholder education, Center of Excellence and Access Agreements.
- Monitors and evaluates the department and staff for continual improvement of the efficiency and effectiveness of the group and provide individuals with professional and personal growth, training and development.
- Utilizes operational metrics and reports to track trend and results adjusting workflows accordingly.
- Participates in the development and communication of internal policies, procedures and systems utilization.
- Supports technological and vendor initiatives for the enhancement and efficiency of the clinical cost containment process.
- Participates in new client implementation, industry meetings, product development and enhancement.
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The Underwriting Assistant provides support to the EmCap Underwriting team. Main duties include the set up process for all groups submitted for captive quoting. Interactions will be with underwriters, sales representatives and possibly outside producers. Duties and responsibilities include but are not limited to:
- Setting up folders in our shared drive for all information received for new submissions
- Running Census Reports in excel spreadsheets for each submission
- Logging submissions in the David Young system including benefits reinsurance forms and census data
- Communicating between Sales Representatives and Underwriters to ensure all information is complete and accurate.
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Are you passionate about understanding client needs, telling stories with data, and using technology to improve marketing effectiveness? If so, we can put you to work as our Marketing Strategist working on challenging projects that will let you make your mark. In this newly created position, you’ll develop and implement research and marketing automation strategies. You’ll serve in a highly visible role, working with others across the organization to improve customer insights, thought leadership, and marketing measurement. You can drive projects that matter to our continued growth. This is a great opportunity to help build the marketing infrastructure for a rapidly growing business. Duties and responsibilities include but are not limited to:
Research and consulting
- Develop and execute a strategy to gather customer feedback
- Lead research efforts to collect broker and marketplace insights
- Analyze research and share insights with the leadership team to inform our long-term business strategy
- Collaborate with corporate marketing on joint strategic marketing programs
- Work on other quantitative and qualitative research projects and manage external vendors
Thought leadership
- Help us become a thought leader in the marketplace through internal and external research
- Help translate research into stories through white papers, videos, and other content
- Develop and execute a strategy to gather and document customer testimonials and case studies
Technology and content delivery
- Identify ways to make our marketing content scalable to accommodate business growth
- Develop and execute strategies for automated content delivery, such as: content management systems, slide repositories, webinars, podcasts, videos, Salesforce campaigns, and other martech tools
- Act as owner of our content management technology and provide reporting to track and assess the success of content and campaigns
- Stay informed on solutions to improve our marketing processes through the use of technology and results tracking and recommend ideas for improvement
- Set annual project plans and research, recommend, and manage vendors
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Berkley Accident and Health is seeking a full time IT & Data Infrastructure Lead located in either Hamilton Square, NJ or remotely. This position is predominately responsible for driving all aspects and components of data management and analytics, creating the strategy for use of external systems, and ongoing systems build and maintenance. S/he is responsible for developing and executing the overall vision, mission, goals and strategies for the IT department of Berkley Accident and Health. Supervises 4 colleagues both on and off shore. Duties and responsibilities include but are not limited to:
- Developing and handling comprehensive project portfolios, budgets, resource allocations, and costs for all IT related projects.
- Managing technology infrastructure
- Monitoring adherence to IT best practices and taking corrective action as required
- Assisting in the day-to-day administration and support of IT
- Collaborating with Berkley Technology Solutions (BTS) team as needed
- Assembling large, complex data sets that meet functional/non-functional business requirements.
- Building the infrastructure required for optimal extraction, transformation, and loading of data from a wide variety of data sources into an appropriate platform
- Developing sessions for data cleansing, manipulation and loading
- Working independently to implement programming methodologies, standards, and procedures
- Delivering quality code within scope and on time
- Analyzing technical needs, requirements, and state of the server, storage and virtualization infrastructure design, integration, and operations
- Recommending, developing, implementing and maintaining new and existing data technology infrastructures
- Managing Information Technology operations staff
- Leading efforts to research and test new technology to improve services
- Developing processes to streamline and automate routine tasks
- Evaluating workload of staff to ensure projects are on time; affecting change when necessary
- Proactively engaging with internal customers, product development team, and management to determine customer needs leading to the development and execution of business strategy
- Analyzing problems and communicating with end users and department managers to assess needs and determine optimum solutions, changes or concerns.
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Berkley Accident and Health is seeking a full time Senior Stop Loss Underwriter for the EmCap Employer Group. This position is a great fit for an experienced ESL underwriter with a minimum of 10 years of experience. The selected candidate will underwrite, evaluate risk, make clinical evaluations in conjunction with clinical staff, and build and maintain profitability on an assigned block of new and renewal business in an assigned territory. The role can be based in Hamilton New Jersey, Marlborough Mass, Souderton PA or be based REMOTE.
Specific duties and responsibilities include but are not limited to:
- Use knowledge of Stop Loss market to build and maintain a profitable book of business
- Review, evaluate, underwrite and quote employer stop loss risks within assigned letter of authority
- Conduct medical underwriting and claimant risk assessment
- Drive sales and underwriting for specified territory while maintaining profitability
- Mentor and train lesser experienced Underwriters
- Work collaboratively with assigned sales representatives and account managers to develop and grow territory
- Manage, maintain and handle territorial assignments
- Accurately and thoroughly document files and record underwriting thought processesanage sold case preparation and issuance of applications