Acadia Insurance (a Berkley Company) ยท 1 month ago
Quality Audit and Training Specialist
US-NJ-Hamilton Square
Full-time
Hybrid
Mid Level
$70K/yr - $90K/yr
3+ years expAcadia Insurance, a Berkley Company, is a risk management firm focused on providing innovative solutions for its clients. The Quality Audit and Training Specialist will be responsible for performing quality reviews of claim submissions and ensuring accurate processing and eligibility determinations.
Commercial InsuranceInsurance
No H1B
Responsibilities
Process an average of 5 to 7 claims per day
Maintain a processing accuracy of 99% or better
Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
Review and adjudicate claims within approved authority limits
Maintain assigned claim block and assist other team members while meeting departmental guidelines
Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc
Elevate issues to next level of supervision, as appropriate
Other duties as assigned
Qualification
Required
3-5+ years stop loss claims experience
Prior experience handling first dollar payer insurance (medical healthcare claims)
Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing
Ability to use mathematics to adjudicate claims
Detail oriented with a high degree of accuracy and ability to multitask
Strong problem solving, decision-making, reporting and analytical skills
Must possess good judgment and work effectively with internal business areas, peers and co-workers
Demonstrated proficiency in Microsoft Office software
Preferred
Prior experience handling stop loss claims at the reinsurance level (medical healthcare claims)
Ability to work independently, prioritize, organize and assign own work to meet deadlines
Ability to accept changing priorities with a minimum of disruption
Benefits
Health
Dental
Vision
Life
Disability
Wellness
Paid time off
401(k)
Generous profit-sharing plan
Company
Acadia Insurance (a Berkley Company)
Acadia Insurance specializes in commercial property casualty insurance. Our company began in 1992 insuring businesses in Maine.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Simone Grimes, CPA, MBA
Chief Financial Officer
Steve Rich, CPCU
Senior Vice President & Chief Claims Officer
Recent News
2024-03-06
Coverager - Insurance news and insights
2022-06-28
Company data provided by crunchbase