Medical Stop Loss Claims Auditor

Who are we?
A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway’s insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character.

We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty and specialty lines insurance company in the world?

Learn more about our unique culture and history.

Job Opportunity:

Berkshire Hathaway Specialty Insurance (BHSI) has an exciting opportunity for a Medical Stop Loss 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) on a daily basis in our Claims Teams with interaction with several other areas in our Medical Stop-Loss Division.

Duties & 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

Qualifications, Skills and Experience:

• 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

BHSI Offers:
• A competitive package and exciting growth opportunities for career-oriented teammates
• A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates and our other stakeholders
• A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework

NOTE: Compensation will be commensurate with experience. This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization