Claims Supervisor (Stop Loss)

Company Details

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.

The company is an equal employment opportunity employer.

Responsibilities

We have an opportunity for a Claims Supervisor to join our Berkley Accident and Health captives team. You will be responsible responsible for processing claims, claims reviews and process improvement and efficiencies.

You will also be responsible for the technical support of a team of Claim Analysts and maintaining a culture of innovation, creativity, autonomy and teamwork.

You will collaborate with leadership to identify and implement strategies to improve claim performance and develop relationships both internally and with external clients.

Assist and collaborate within the team to solve complex and costly medical reimbursement issues.

We have a welcoming culture valuing our employees we trademarked the phrase Everything Counts, Everyone Matters® to describe the Berkley commitment to our people and how we do business.

We believe that every person in the organization is important and every accomplishment makes a difference in our results. Come join us!

Key functions include but are not limited to :

Handle analyst claims questions including facilitating and directing the analysts towards a resolution of the claim issue.

Depending on complexity of issue, leader may have to take ownership of file.

• Process an average of 2-3 claims a day, while maintaining a processing accuracy of 99% or better.
• Review all over-authority claims, escalating those over their own authority threshold to the Manager for continued review.
• Act as a Claim Ombudsman, who will triage questions that arise from Account Managers / Program Managers and Sales, when necessary.
• Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.
• Review and approve claim denial letters for analysts.
• Provide feedback to Manager on performance evaluations.
• Provide new analyst training after and ongoing training, as necessary.
• Evaluate need for future training areas based on questions and issues presented by team members and communicate to Claims Manager and Quality Assurance Manager.
• Other duties as assigned.

Qualifications

• Bachelors Degree or equivalent experience
• 5-10 years Stop Loss and 1st Dollar Medical Claims Adjudication.
• Minimum 3+ years supervisory experience required.
• Excellent leadership abilities and able to motivate staff.
• Knowledge of medical terminology, ICD9, ICD10, CPT, and HCPC codes.
• Proficiency with Microsoft Office applications.
• Excellent analytical, problem solving, time management, and organizational skills, with a high attention to detail. Analyses relevant aspects of a situation before reaching a conclusion;

does not hesitate to act when required.

• Ability to provide innovative ideas for improvements.
• Ability to establish and maintain positive working relationships with all operational areas, and management to further the company's mission.
• Customer focused, pro-active mindset with excellent organizational, interpersonal and project management skills.
• Ability to demonstrate a high level of service delivery; do what is necessary to ensure customer satisfaction; deal with service failures and prioritize customer needs.
• Ability to work productively while maintaining excellent quality, demonstrate initiative and take ownership of tasks to completion.
• Solid work ethic, positive attitude, and a strong sense of accountability.

Additional Company Details We do not accept any unsolicited resumes from external recruiting firms.

The company offers a competitive compensation 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, complexity 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