Sr. Claims Analyst

Berkley • Hamilton Square, NJ

3d • Hybrid

About The Position

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. This position can either be fully remote (if not within commutable distance to the office) or based in one of our offices: Hamilton Square, NJ West Hartford, CT Marlborough, MA Harleysville, PA. We offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so. The Company is an equal employment opportunity employer.

Requirements

• 5+ years of Stop Loss claims, reinsurance claims, or Stop Loss auditing experience
• Strong understanding of Stop Loss contracts, claim reimbursement provisions, and policy interpretation
• Experience evaluating complex medical claims and supporting documentation
• Excellent analytical, problem-solving, and decision-making abilities
• Strong written and verbal communication skills
• Ability to effectively prioritize workloads and manage deadlines independently
• Proficiency with Microsoft Excel and Microsoft Office applications
• High School Diploma

Nice To Haves

• Deep expertise in Stop Loss reimbursement analysis
• Ability to navigate complex and ambiguous claim situations with confidence
• Process improvement mindset with a focus on operational excellence
• Strong relationship-building skills and ability to influence across teams
• Experience serving as a mentor or subject matter expert
• Passion for delivering accurate, defensible claim decisions

Responsibilities

• Review and audit Stop Loss claim submissions to determine reimbursement eligibility
• Analyze complex medical claims and apply contract provisions to claim decisions
• Handle high-severity, challenging, and escalated claim situations independently
• Review medical documentation, plan specifications, and contractual language to support claim determinations
• Document claim rationale with accuracy and consistency
• Resolve claim discrepancies, reconciliation issues, and complex problem cases
• Maintain production and quality standards while managing an assigned claim inventory
• Provide guidance and expertise to internal business partners and claims colleagues
• Mentor and support newer team members
• Help drive best practices and continuous improvement initiatives
• Ensure compliance with HIPAA, ACA, privacy requirements, and other applicable regulations

Benefits

• competitive compensation
• paid time off
• comprehensive wellness benefits and programs
• employer funded health savings account
• profit sharing
• 401k
• paid parental leave
• employee stock purchase plan
• tuition assistance and professional continuing education
• Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and generous profit-sharing plan

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED