Workers Compensation, Medical Bill Review, Operations Analyst

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🕒 il y a 1 mois

⚔️ Virginia – Distant

⚔️ Virginia – Remote

💵 $75 000 - $95 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

⚙️ Opérations

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W. R. Berkley Corporation

Site WebLinkedInTous les Emplois

5001 - 10000 employés

Fondée en 1967

💸 Finance

🤝 B2B

Insurance • Finance • B2B

W. R. Berkley Corporation est une entreprise d'assurance de premier plan opérant à travers plus de 55 entités, offrant une large gamme de solutions d'assurance pour les clients commerciaux et les particuliers fortunés. Avec une expertise approfondie dans divers secteurs, Berkley se spécialise dans l'offre de produits d'assurance sur mesure qui répondent aux marchés de niche. L'entreprise met l'accent sur des partenariats solides avec les agents et les courtiers pour offrir une couverture pour les risques uniques et les besoins émergents, garantissant une protection complète pour ses clients.

Description

• Serve as a subject-matter expert for Medical Bill Review (MBR) operations; • Provide advanced production support and drive process improvements; • Coordinate cross-functional issue resolution and project execution; • Support processing of workers’ compensation medical and pharmacy bills from bill intake through payment; • Investigate bill processing issues and problem-solve; • Interface with multiple vendors for issue resolution; • Monitor business dashboards and vendor reports daily for TAT trends; • Recommend workflow enhancements and document trends and issues for improvement; • Build and maintain relationships with internal teams, external vendors, and medical providers.

🎯 Exigences

• MBR business process SME including experience with MBR E2E 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; • workers compensation regulatory environment experience/understanding; • Demonstrated application of successful critical thinking and complex problem solving skills; • Experience in a role requiring deep understanding of and experience working with MBR and integrated services technology; • Experience gathering business requirements and clearly documenting complex scenarios and use cases; • Communication experience with varied audiences including leadership and peers in business/operational & technology roles; • Client-facing acumen; • Team-player; • Experience with Atlassian/JIRA/SQL. • 5 years in a multi-faceted workers compensation MBR role demonstrating increasing responsibility with required skills outlined above within that time or 3 years in an MBR role + 2 years in position with similar responsibilities.

🏖️ Avantages

• Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.