Senior Stop Loss Claims Auditor

Summary Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Description Position Purpose Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Companion Life – one of Blue Cross Blue Shield's South Carolina subsidiary companies.

Location:

This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST and will be fully remote.

• Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier.
• Recognize cost mitigation opportunities.
• Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.
• Initiate claims investigations and vendor referrals.
• Interpret plan language, and identify experimental services and subrogation opportunities.
• 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 to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history.
• Develop new and review old stop loss claim forms.
• Assist with internal auditing of claims auditors, and training of claims auditors.

Required

Education:

Associate's Degree Equivalency: 2 years of job-related work experience Required

Work Experience:

6 years of managed care or reinsurance claims experience.

• Analyzes laws, regulations and contract language.
• Evaluates issues and develops recommendations.
• Handles confidential and sensitive information.
• Investigates assigned claims.
• Proposes claims adjustments and refunds.
• Works claims caseloads.
• Aggregate claims experience.

• 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

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Range Minimum $49,447.00 Range Midpoint $72,092.00 Range Maximum $94,737.00

Pay Transparency Statement:
Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

Blue Cross Blue Shield 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 individuals with disabilities and protected 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…