Senior Stop Loss Claims Auditor

🔥 0 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $49.4k - $94.7k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

💸 Finance

Healthcare Insurance • Insurance • Finance

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 • Effectively mitigate client medical stop loss claims and provide excellent customer service • Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier • Recognize cost mitigation opportunities • Authorize and release stop loss claims reimbursement checks • Initiate claims investigations and vendor referrals • Interpret plan language and identify experimental services • 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 • Develop new and review old stop loss claim forms • Assist with internal auditing of claims auditors and training of claims auditors

🎯 Requirements

• Associate's Degree or 2 years of job-related work experience • 6 years of managed care or reinsurance 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