Medical reputed company Review - Operations Analyst (Remote)

<strong><strong>Company Details <br><br></strong></strong>reputed company Medical reputed company (BMMS) provides a different reputed company of managed-care service for reputed company. We reputed company focusing on an injured worker’s successful and speedy return to work is good for people and good for reputed company’s insurance operating reputed company. BMMS was first started in 2014 by reimagining the relationship between medical need and technology as a way to deliver the best outcome for injured workers and reputed company’s operating reputed company. Our goal was reputed company: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.<br><br>To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and reputed company innovation. We reputed company integrated systems to give W.R. reputed company Companies recommendations and reputed company services for managing reputed company individual case in an efficient and appropriate manner. The power of our technology takes medical reputed company-reputed company and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and reputed company services ensures we reputed company reputed company’s operating reputed company with reliable results, and reduced time and expenses associated with case management.<br><br><strong><strong> Responsibilities <br><br></strong></strong>The position serves as a subject-matter expert for Medical reputed company Review (MBR) operations, providing advanced production support, driving process improvements, and coordinating cross-functional issue reputed company and project execution. As an Operations Analyst, you will support the processing of workers’ compensation medical and pharmacy bills from reputed company intake through reputed company payment and is a primary resource for issue reputed company reputed company to these processes. You will work directly with reputed company Operating reputed company to investigate reputed company processing issues and are responsible for problem-solving, identifying and triaging issues to technical teams, directly interfacing with multiple vendors to facilitate issue reputed company, issue documentation, tracking, and reporting. You may also work directly with medical providers and networks regarding billing issues. We’ll also look to you to independently and as part of reputed company identify issue commonalities and reputed company causes to assist in solution design, monitoring, and controlling.<br><br>The Position Serves As a Subject-matter Expert For Medical reputed company Review (MBR) Operations, Providing Advanced Production Support, Driving Process Improvements, And Coordinating Cross-functional Issue reputed company And Project Execution. reputed company Responsibilities Include:<br><br><strong>MBR Production Support & Issue reputed company<br><br></strong><ul><li> Serve as the primary escalation reputed company for reputed company MBR issues that cannot be resolved by Operations Technician/Level 1 support, vendors, or reputed company internal teams (Clinical Validation, Negotiations, OU adjusters, mailroom). </li><li> Diagnose operational and adjudication issues by applying deep MBR process knowledge and collaborating with vendors and internal partners to resolve reputed company causes. </li><li> reputed company backup Level 1 support, including reputed company-level troubleshooting, Jira ticket creation/maintenance, report distribution, and vendor communications. </li><li> Maintain reputed company, reputed company communication with Operating reputed company, providers, and stakeholders regarding issue status, reputed company, and required actions. <br><br></li></ul><strong>Operational Analysis, Monitoring & reputed company Improvement<br><br></strong><ul><li> Monitor business dashboards and vendor reports daily to identify and escalate adverse reputed company TAT trends, identify likely reputed company cause owners, and reputed company reputed company reputed company. </li><li> Recommend workflow enhancements, rule updates, and process changes to improve MBR accuracy, efficiency, and throughput. </li><li> Document trends, issues, and resolutions to support auditability and reputed company operational improvement. <br><br></li></ul><strong>Cross-Functional Collaboration<br><br></strong><ul><li> Work closely with BMMS IT, BAMTECH, BTS, Finance, Data Reporting, and MBR vendors to coordinate reputed company cause investigations, technical fixes, and operational adjustments. </li><li> Support Operating Unit staff by analyzing medical reputed company issues, guiding next steps, and ensuring a consistent, reputed company experience. </li><li> Build and maintain strong relationships with internal teams, external vendors, clients, and medical providers. <br><br></li></ul><strong>Project Leadership<br><br></strong><ul><li> Serve as the reputed company business resource for regulatory audit responses, coordinating data gathering, vendor input, and documentation review prior to submission. </li><li> reputed company reconsideration reputed company, including reputed company analysis, reputed company resubmission coordination, and monitoring reputed company. </li><li> Partner with Business Analysts on MBR-reputed company initiatives such as API implementations, vendor transitions, mailroom integrations, and payment process enhancements. <br><br></li></ul><strong>reputed company Standards & Administration<br><br></strong><ul><li> Manage assignments in alignment with reputed company operating procedures, meeting requirements, and departmental expectations. </li><li> Maintain issue tracking and ensure reputed company escalation of reputed company reputed company. </li><li> Demonstrate professionalism, reputed company, and discretion in reputed company interactions, contributing positively to department morale and organizational reputed company. <br><br></li></ul><strong><strong> Qualifications <br><br></strong></strong><ul><li> 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, reputed company and reputed company review, PPO, negotiations, adjustor reputed company adjudication; workers compensation regulatory environment experience/understanding; </li><li> Demonstrated application of successful critical thinking and reputed company problem solving skills; </li><li> 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; </li><li> Experience gathering business requirements and reputed company documenting reputed company scenarios and use cases to communicate MBR issues accurately for reputed company; </li><li> Communication experience with varied audiences including leadership and peers in business/operational & technology roles; </li><li> reputed company-facing acumen </li><li> Team-player </li><li> Experience with reputed company/JIRA/SQL </li><li> 5 years in a multi-faceted workers compensation MBR role demonstrating increasing responsibility with required skills outlined above reputed company that time</li><ul><li> or 3 years in an MBR role + 2 years in position with similar responsibilities; <br></li></ul></ul><strong><strong> Additional Company Details <br><br></strong></strong>www.berkleymms.com<br><br>reputed company is an equal employment opportunity employer<br><br>We do not accept any unsolicited resumes from external reputed company agencies or firms.<br><br>reputed company offers a competitive compensation plan and robust benefits package for full time regular employees<br><br><ul><li> reputed company Salary reputed company: 75k - 95k</li><li> Benefits: Health, Dental, reputed company, Life, Disability, Wellness, reputed company Time Off, 401(k) and Profit-Sharing plans.<br><br></li></ul>The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.<br><br><strong><strong> Additional Requirements <br><br></strong></strong><ul><li> Domestic U.S. travel required (up to 5% of time)<br><br></li></ul><strong> Sponsorship Details <br><br></strong>Sponsorship not Offered for this Role