Summary
 

Responsible for submitting stop loss claim packets and responding to any requests for additional information. Additionally, the claims must be tracked and monitored. Complex analysis is performed and queries are generated to file and validate the claim submissions.

Description
 

Description
 

Logistics:

This position is full time (40 hours/week) Monday-Friday, with typical work hours between 7:30 am – 5:00 pm in a hybrid setting, working from home and onsite at 4101 Percival Rd., Columbia, SC.

What You Will Do:

• Prepares and files 50% and 100% stop loss claim packets. Run queries, compiles eligibility data and submits claim packet.

• Audits stop loss positions by running queries and comparing to the accumulated claims in the billing system. Researches variances, document discrepancies and make appropriate adjustments.

• Responds to audit letters. Works with other areas including claims, marketing and managed care to obtain requested information.

• Tracks claims packet filing and MGU responses. Logs all submissions, audit letters receipts and responses in the tracking database/log.

• Provides manual monitoring of special stop loss scenarios including carved out pharmacy. Ensures the member's stop loss positions are properly tracked and updated.

• Performs complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions. Creates custom reports and spreadsheets based on customer inquiries.

To Qualify for This Position, You Will Need:

• Required Education: Bachelor's in a job related field

• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

• Required Work Experience: 3 years in accounting, auditing, billing, claims, membership, or finance.

• Required Skills and Abilities:  Ability to compile information, perform research and analyze data. Strong customer service and organizational skills. Excellent verbal and written communication skills. Ability to take initiative and meet deadlines. Attention to detail.

• Required Software and Tools: Microsoft Office including Access

We Prefer That You Have:

• Preferred Work Experience: Experience within a self-funded insurance programs.

• Preferred Software and Other Tools: Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience.

• Work Environment: Typical office environment.

What We Can Do for You:

• 401(k) retirement savings plan with company match.

• Subsidized health plans and free vision coverage.

• Life insurance.

• Paid annual leave – the longer you work here, the more you earn.

• Nine paid holidays.

• On-site cafeterias and fitness centers in major locations.

• Wellness programs and healthy lifestyle premium discount.

• Tuition assistance.

• Service recognition.

• Incentive Plan.

• Merit Plan.

• Continuing education funds for additional certifications and certification renewal.

What to Expect 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 minorities, females, disabled individuals, and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will decide 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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.