Claims Analyst Position Available In Gwinnett, Georgia

Claims Analyst
Location Name
GA, Lawrenceville

ID 2024-10999

Date Posted 1 month ago
(4/2/2025 4:32 PM)
Company Berkley Accident & Health Primary Location
US-GA-Lawrenceville Loc2 CT, West Hartford – 433 S Main Street Suite 200 Loc3 PA, Kulpsville Loc4 MA, Marlborough – 400 Donald J Lynch Boulevard Loc5 Southeast US Region Loc6 Midwest US Region Category Claims
Company Details
Berkley Accident and Health is a risk managementpany 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 500pany. Our parentpany, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.
Thepany is an equal employment opportunity employer.
Responsibilities
We have an opportunity for a Stop Loss Claims Analyst to join our Berkley Accident and Health team! You will perform quality review and evaluation of all claim submissions received and logged into our claims system to determine whether the amount requested is eligible for reimbursement. We are open with location, including remote options
We have a weing culture valuing our employees – we trademarked the phrase Everything Counts, Everyone Matters® to describe the Berkleymitment to our people and how we do business. We believe that every person in theanization is important and every aplishment makes a difference in our results. Come join us! Key functions 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 ing 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
Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.
Elevate issues to next level of supervision, as appropriate
Other duties as assigned
Qualifications
5+ years stop loss claims experience
Prior experience handling first dollar payer insurance (medical healthcare claims)
Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing
Ability to use mathematics to adjudicate claims
Detail oriented with a high degree of accuracy and ability to multitask
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
Ability to work independently, prioritize,anize and assign own work to meet deadlines Demonstrated proficiency in Microsoft Office software
Additional Company Details
We do not accept any unsolicited resumes from external recruiting firms.
Thepany offers apetitivepensation plan and robust benefits package for full time regular employees.
The actual salary for this position will be determined by a number of factors, including the scope,plexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Sponsorship Details
Sponsorship not Offered for this Role