Job Description

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

What You\xe2\x80\x99ll Do

• Prepare and file 50% and 100% stop loss claim packets.
• Run queries, compile eligibility data and submit claim packet.
• Audit stop loss positions by running queries and comparing to the accumulated claims in the billing system.
• Research variances, document discrepancies and make appropriate adjustments.
• Respond to audit letters.
• Work with other areas including claims, marketing and managed care to obtain requested information.
• Track claims packet filing and MGU responses.
• Log all submissions, audit letters receipts and responses in the tracking database/log.
• Provide manual monitoring of special stop loss scenarios including carved out pharmacy.
• Ensure the member\'s stop loss positions are properly tracked and updated.
• Perform complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions.
• Create custom reports and spreadsheets based on customer inquiries.
• Work environment: Typical office environment. Percival Road location.
• The position has the potential to be

Flexible work arrangement after the initial three months of training in office. Working hours are 7:30 to 4:00 PM

To Qualify for this Position, You\xe2\x80\x99ll Need

• Bachelor\'s Degree in Business, Finance, or other related field OR Four (4) years of stop loss and/or claims billing experience may be substituted for a Bachelor\'s Degree.
• Three (3) years in accounting, auditing, billing, claims, membership, or finance. (May be concurrent).
• 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.
• Microsoft Office including Access.

We Prefer That You Have

• Experience within a self-funded insurance programs.
• Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience.

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 our 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.

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 abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

BlueCross BlueShield Of South Carolina