Senior Stop Loss Claims Auditor

🕒 July 17

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $49.4k - $94.7k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

👻 Ghost score 53%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

BlueCross BlueShield of South Carolina is a leading health insurance provider that offers a variety of health plans, including individual and family plans, Medicare options, and group health plans. The organization focuses on providing coverage and resources for members, employers, and healthcare providers, ensuring access to quality healthcare services. With a commitment to promoting healthier lifestyles and supporting community health, BlueCross BlueShield of South Carolina plays a vital role in the healthcare landscape of the region.

📋 Description

• Audit and authorize reimbursement of specific medical stop loss claims • Mitigate client medical stop loss claims and provide excellent customer service • Analyze and adjudicate stop loss claims and request appropriate reimbursement from carriers • Recognize cost mitigation opportunities • Authorize and release stop loss claims reimbursement checks at or below preset authority limits • Initiate claims investigations and vendor referrals • Interpret plan language and identify experimental services and subrogation opportunities • Identify follow-up needs for pended claims and resolve them • Communicate with carriers, vendors and management regarding claims • Provide claims service for phone and written inquiries • Generate and maintain claims system reports to adjust reserves and identify pending and backlog claims • Provide renewal and enrollment/premium history • Develop new and review existing stop loss claim forms • Assist with internal auditing and training of claims auditors

🎯 Requirements

• Associate's degree required • Degree equivalency: 2 years of job-related work experience • 6 years of managed care or reinsurance claims experience • Ability to analyze laws, regulations and contract language • Ability to evaluate issues and develop recommendations • Ability to handle confidential and sensitive information • Experience investigating assigned claims • Ability to propose claims adjustments and refunds • Experience working claims caseloads • Aggregate claims experience

🏖️ Benefits

• 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 • Benefits eligibility for the first of the month following 28 days of employment