Workers Compensation, Medical Bill Review, Operations Analyst

Job not on LinkedIn

🕒 April 28

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $75k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 23%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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W. R. Berkley Corporation

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1967

🛡️ Insurance

💸 Finance

🤝 B2B

Insurance • Finance • B2B

W. R. Berkley Corporation is a leading insurance company that operates through over 55 businesses, providing a wide range of insurance solutions for both commercial and high-net-worth individual clients. With deep expertise in various industries, Berkley specializes in offering tailored insurance products that cater to niche markets. The company emphasizes strong partnerships with agents and brokers to deliver coverage for unique risks and emerging needs, ensuring comprehensive protection for its customers.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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