Senior Claims Auditor, Medical Stop Loss

Berkshire Hathaway Specialty Insuance•Indianapolis, IN

58d•$70,000 - $80,000

About The Position

Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for a Medical Stop Loss Senior Claims Auditor with knowledge of employer group health insurance, managed care, and direct medical claims products. This position will work with our Third-Party Administrator's (TPA's) daily with interaction with several other areas in our Medical Stop-Loss Division. The position is preferably located in our Indianapolis or Plymouth Meeting, PA office. We are open to candidates who could work from out Atlanta or Boston office as well.

Requirements

Minimum of 5+ years' experience examining and auditing medical stop loss claims
Proficient with Microsoft Office Suite, especially Excel
Knowledge of group insurance, managed care, and direct medical claims products
Demonstrate excellent mathematical, communication and customer service skills
Excellent problem-solving and critical-thinking skills
Detail/results-oriented
Strong analytical skills
Excellent customer service
Knowledge of COB, Medicare, HIPAA, CPT, ICD9/ICD10, and interpretation of employer group health plan benefits
Ability to work independently with minimal supervision while meeting or exceeding established turn-around-time, production, and accuracy standards

Responsibilities

Audit specific and aggregate claims for assigned complex blocks of business
Audit and process claim reimbursements
Verify claims are paid in accordance with the plan document and reimbursable under the Stop Loss policy
Verify participant and dependent eligibility
Maintain and exceed targeted claims accuracy standards
Maintain accurate and detailed information for each file
Conduct implementation calls for newly sold groups
Review and approve plan documents and plan amendments
Initiate and further cost containment opportunities
Audit program business claims across several lines within our Accident & Health Division
Assist management with implementation calls for new business sold
Set and adjust reserves