Senior Stoploss Claim Auditor (Remote)

Logistics:

• This is a full time (40 HPW) position, and this role is approved for telework/remote work location within the United States.

• Travel to and from the training location is required as well as limited travel to client sites as determined by business need.

What You'll Do:

• Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.

• Initiate claims investigations and vendor referrals. Interpret plan language and identify experimental services and subrogation opportunities.

• Identify need for follow-up on pended claims and resolution.

• Communicate effectively with carriers, vendors, and management. Provide full claims service to both phone and written inquiries.

• Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history.

• Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors, and training of claims auditors.

• This role is approved for telework/remote work location within the United States.

• Travel to and from the training location is required as well as limited travel to client sites as determined by business need.

To Qualify for This Position, You'll Need the Following:

• Required Education: Associate degree, OR two years of medical claims and/or reinsurance claims experience.

• Required Work Experience: Six years of medical claims and/or reinsurance claims experience.

• Preferred Work Experience: Prior Stop Loss insurance experience. High comfort level with providing excellent customer service.Working knowledge of medical terminology.

• Required Skills and Abilities: Excellent customer-service, organizational and critical-thinking skills. Detail/results-oriented. Strong analytical skills.

• Knowledge of group insurance, managed care and direct medical claims products.

• Advanced knowledge of aggregate claims auditing.

• Knowledge in COB, Medicare, HIPAA, CPT, ICD-9 and benefit plan interpretation.

• Ability to work independently with minimal supervision while meeting or exceeding established production and accuracy standards.

• Ability to persuade, negotiate with or influence others. 

• Proficient with Microsoft Office Products.

• Work Environment Requirements: This role is a w@h position, however, requires travel, as needed.

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits on the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more! ​

What We Can Do for You: 

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have an opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Except Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision.

We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement:

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual; orientation, gender identity, genetic information or any other legally protected status.

Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state, and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbsasc.com or call 800-288-2277, ext.47480 with the nature of your request. We will make a decision regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

Some states have required notifications. Here's more information.