Stop Loss Claims Quality Assurance Analyst
Location
United States
Posted
5 days ago
Salary
$80K - $90K / year
No structured requirement data.
Job Description
Role Description
As a Stop Loss Claims Quality Assurance Analyst, you'll conduct claims related operational functions that focus 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
- 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 received 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
- 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 oriented 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.
Requirements
- Experience with David Young Claims System (Connexure)
- Previous audit experience a plus but must have knowledge of audit concepts and skills.
Benefits
- Base Salary Range: $80,000 to $90,000
- Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
Job Requirements
- 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 oriented 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.
- Experience with David Young Claims System (Connexure)
- Previous audit experience a plus but must have knowledge of audit concepts and skills.
Benefits
- Base Salary Range: $80,000 to $90,000
- Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
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