Workers Compensation - Medical Bill Review - Operations Analyst (Remote)

Berkley•Manassas, VA

8d•$75,000 - $95,000•Remote

About The Position

Berkley Medical Management Solutions (BMMS) provides a managed-care service for W.R. Berkley Corporation, focusing on the injured worker’s successful and speedy return to work. BMMS was established in 2014 by integrating clinical practices, return-to-work strategies, and software for seamless management of workers’ compensation cases. They utilize a flexible technology platform for customization and expansion, deploying integrated systems to manage individual cases efficiently. Their technology enhances medical bill-review and clinical advisory services through a combination of technology, software platforms, data analytics, and professional services, aiming to provide reliable results and reduce case management time and expenses.

Requirements

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 – not at a developer level – but from a business analyst perspective.
Experience gathering business requirements and clearly documenting complex scenarios and use cases to communicate MBR issues accurately for resolution.
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.

Responsibilities

Serve as the primary escalation point for complex Medical Bill Review (MBR) issues that cannot be resolved by Operations Technician/Level 1 support, vendors, or related internal teams.
Diagnose operational and adjudication issues by applying deep MBR process knowledge and collaborating with vendors and internal partners to resolve root causes.
Provide backup Level 1 support, including bill-level troubleshooting, Jira ticket creation/maintenance, report distribution, and vendor communications.
Maintain timely, clear communication with Operating Units, providers, and stakeholders regarding issue status, outcomes, and required actions.
Monitor business dashboards and vendor reports daily to identify and escalate adverse bill TAT trends, identify likely root cause owners, and track resolution progress.
Recommend workflow enhancements, rule updates, and process changes to improve MBR accuracy, efficiency, and throughput.
Document trends, issues, and resolutions to support auditability and continuous operational improvement.
Work closely with BMMS IT, BAMTECH, BTS, Finance, Data Reporting, and MBR vendors to coordinate root cause investigations, technical fixes, and operational adjustments.
Support Operating Unit staff by analyzing medical bill issues, guiding next steps, and ensuring a consistent, professional experience.
Build and maintain strong relationships with internal teams, external vendors, clients, and medical providers.
Serve as the lead business resource for regulatory audit responses, coordinating data gathering, vendor input, and documentation review prior to submission.
Lead reconsideration projects, including impact analysis, bill resubmission coordination, and monitoring outcomes.
Partner with Business Analysts on MBR-related initiatives such as API implementations, vendor transitions, mailroom integrations, and payment process enhancements.
Manage assignments in alignment with standard operating procedures, meeting requirements, and departmental expectations.
Maintain issue tracking and ensure timely escalation of complex matters.
Demonstrate professionalism, tact, and discretion in all interactions, contributing positively to department morale and organizational reputation.