Operations Analyst

About the role

Berkley Medical Management Solutions (BMMS) provides a managed-care service for W.R. Berkley Corporation focused on speedy return-to-work for injured workers. BMMS combines clinical practices, return-to-work strategies, and a flexible technology platform to deliver efficient workers’ compensation case management. The company integrates systems to provide recommendations and professional services for managing individual cases, leveraging technology, software platforms, data analytics, and professional services to deliver reliable results and reduce case management time and expenses.

Responsibilities

The Operations Analyst serves as a subject-matter expert for Medical Bill Review (MBR) operations, providing advanced production support, driving process improvements, and coordinating cross-functional issue resolution and project execution. Core responsibilities include:

MBR Production Support & Issue Resolution

• Serve as the primary escalation point for complex MBR issues that cannot be resolved by Operations Technician/Level 1 support, vendors, or related internal teams (Clinical Validation, Negotiations, OU adjusters, mailroom).
• 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.

Operational Analysis, Monitoring & Continuous Improvement

• 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.

Cross-Functional Collaboration

• 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.

Project Leadership

• 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.

Professional Standards & Administration

• 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.

Qualifications

• MBR business process SME including experience with MBR end-to-end 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 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 and team-player mentality.
• 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.

Benefits

• Health, Dental, Vision, Life, Disability, and Wellness coverage.
• Paid Time Off.
• 401(k) and Profit-Sharing plans.

Pay

Base Salary Range: $75,000 – $95,000. The actual salary will be determined by 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.

Domestic U.S. travel required (up to 5% of time).