Workers Compensation, Medical Bill Review, Operations Analyst

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🕒 Abril 28

⚔️ Virginia – Remoto

⚔️ Virginia – Remote

💵 $75.000 - $95.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

⚙️ Operações

👻 Score fantasma 24%

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W. R. Berkley Corporation

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

Fundada em 1967

🛡️ Seguros

💸 Finanças

🤝 B2B

Insurance • Finance • B2B

A W. R. Berkley Corporation é uma empresa líder em seguros que opera através de mais de 55 negócios, fornecendo uma ampla gama de soluções de seguros para clientes comerciais e individuais de alto patrimônio. Com profunda expertise em várias indústrias, a Berkley se especializa na oferta de produtos de seguro personalizados que atendem a mercados de nicho. A empresa enfatiza sólidas parcerias com agentes e corretores para oferecer cobertura para riscos únicos e necessidades emergentes, garantindo proteção abrangente para seus clientes.

Descrição

• Serve as subject-matter expert for Medical Bill Review operations • Provide advanced production support and serve as primary escalation point for complex MBR issues • Support processing of workers’ compensation medical and pharmacy bills from intake through payment • Investigate bill-processing issues with Berkley Operating Units • Problem-solve, identify, and triage issues to technical teams • Interface with vendors, medical providers, and networks to facilitate issue resolution • Create and maintain issue documentation, tracking, and reporting • Provide backup Level 1 support, including bill-level troubleshooting, Jira ticket maintenance, report distribution, and vendor communications • Monitor business dashboards and vendor reports daily for adverse bill turnaround-time trends • Recommend workflow enhancements, rule updates, and process changes • Document trends, issues, and resolutions for auditability and continuous improvement • Coordinate root-cause investigations, technical fixes, and operational adjustments with BMMS IT, BAMTECH, BTS, Finance, Data Reporting, and MBR vendors • Support Operating Unit staff by analyzing medical bill issues and guiding next steps • Lead regulatory audit responses, including data gathering, vendor input, and documentation review • Lead reconsideration projects, including impact analysis, bill resubmission coordination, and outcome monitoring • Partner with Business Analysts on API implementations, vendor transitions, mailroom integrations, and payment process enhancements • Manage assignments according to standard operating procedures and departmental expectations • Maintain issue tracking and timely escalation of complex matters

🎯 Requisitos

• MBR business process SME with experience in the end-to-end MBR process from a business/operations perspective • Firm understanding of integrated services and workflows including FS/UCR, Nurse and code review, PPO, negotiations, adjustor bill adjudication, and the workers compensation regulatory environment • Demonstrated critical thinking and complex problem-solving skills • Experience working with MBR and integrated services technology from a business analyst perspective, not a developer level • Experience gathering business requirements and documenting complex scenarios and use cases • Communication experience with leadership, peers, business/operational roles, and technology roles • Client-facing acumen • Team-player • Experience with Atlassian, JIRA, and SQL • 5 years in a multifaceted workers compensation MBR role with increasing responsibility, or 3 years in an MBR role plus 2 years in a position with similar responsibilities • Sponsorship not offered for this role • Ability to travel domestically in the U.S. up to 5% of the time

🏖️ Benefícios

• Health • Dental • Vision • Life • Disability • Wellness • Paid Time Off • 401(k) • Profit-Sharing plans • Competitive compensation plan • Domestic U.S. travel required up to 5% of time