Stop Loss Claims QA Analyst

Company Details

#StopLoss #SelfFunded #accidentandhealth

 

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.

 

This position can either be fully remote (if not within commutable distance to the office) or based in one of our offices:

• Hamilton Square, NJ
• Marlborough, MA

Our offices offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.

 

The Company is an equal employment opportunity employer. 

#LI-AV1 #LI-Remote

Responsibilities

As a Stop Loss Claims Quality Assurance Analyst, you'll conduct claims related operational functions that focuses on Employer Stop Loss quality reviews.  As you learn more about the organization, your role may encompass SOX audits, subrogation referrals, overpayment/check void and refund processing, external auditor requests, and reserve adjustment requests.  You'll be part of a small high-performing team and be a key partner helping shape best practices within the Claims function.  

 

What you can expect:

• Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent
• Internal mobility opportunities 
• Visibility to senior leaders and partnership with cross functional teams
• Opportunity to impact change
• Benefits – competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education

We'll count you to: 

• Be responsible for department quality audit process related to: service standards, adherence to procedural, regulatory and financial requirements.
• Perform SOX related audits.
• Review the referral of, submit, monitor and track all subrogation referrals receive by the Claim department and forwarded to external vendors.
• Handle overpayment, check void and refunds, including maintenance of the overpayment log.
• Handle all external auditor requests for supporting documentation, i.e., KPMG, Captive audits.
• Handle reserve adjustment requests.
• Other duties as assigned 

Qualifications

What you need to have:

• High School Diploma required

• 5+ years of experience in first payer claims and reinsurance industry with a good understanding of our product mix.

• 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 orientated with a high degree of accuracy and ability to multitask.

• Must be highly motivated and able to handle multiple priorities in a consistently changing environment.

• 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 with Microsoft Office software, including Word and Excel.

• Ability to work independently, prioritize and organize own work to meet deadlines.

• Must exhibit a professional behavior at all times while representing or being identified as an employee of Berkley Accident and Health.

What makes you stand out:  

• Experience with David Young Claims System (Connexure)
• Previous audit experience a plus but must have knowledge of audit concepts and skills.

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $80,000 to $90,000 • Benefits: He