Stop Loss Registered Nurse

Job not on LinkedIn

🔥 3 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $70.7k - $140.2k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👻 Ghost score 0%

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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

• Evaluate and manage catastrophic episodes of illness for underwriting and claims • Ensure insured members receive the best medical care in the most cost-effective manner • Facilitate cost estimates for underwriters for new and renewal stop loss business • Consult with underwriters on catastrophic episodes of illness • Provide case management oversight of managed care between the TPA and the company • Review potential claim notices and excess claims to determine reserve settings • Review potential claim notices from TPAs • Research cost containment and intervene with the TPA as necessary • Work Monday-Friday, 40 hours per week, on an 8-hour shift between 6:00am and 6:00pm

🎯 Requirements

• Associates in a job-related field • Graduate of Accredited School of Nursing • 10 years of work experience: 5 years clinical plus 5 years medical management experience • Active RN licensure in state hired • Working knowledge of word processing software • Excellent verbal and written communication skills • Ability to work independently, prioritize effectively, and make sound decisions • Working knowledge of managed care and various forms of health care delivery systems • Working knowledge of catastrophic claims cost, medical vendors, and case management • Demonstrated customer service, communication, and organizational skills • Analytical or critical thinking skills • Ability to handle confidential or sensitive information with discretion • Microsoft Office • Experience working with a stop loss carrier and providing underwriting and claims with medical cost projects • Significant case managed and managed care experience • Experience with Medicare and/or Medicaid • HMO Reinsurance experience • Previous solutions-based consulting experience to partner effectively with a wide range of diverse clients • Ability to review and analyze large amounts of claims data and clinical information

🏖️ 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 • About 25% of travel to visit clients or participate in team meetings or conferences; travel expenses will be reimbursed • Benefits eligibility beginning the first of the month following 28 days of employment