Stop Loss Analyst at BlueCross BlueShield of South Carolina

Columbia, South Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

19 Dec, 25

Salary

0.0

Posted On

20 Sep, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Data Analysis, Customer Service, Organizational Skills, Verbal Communication, Written Communication, Attention to Detail, Initiative, Deadline Management, Microsoft Office, Claims Processing, Auditing, Research, Billing, Finance, Eligibility Data Compilation, Discrepancy Documentation

Industry

Insurance

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 Logistics: This is a full-time position (40 hours/week), Monday through Friday, with typical office work hours in a hybrid setting, working from home and onsite at the 4101 Percival Road Location in Columbia, SC 29229. What You Will Do: Prepares and files 50% and 100% stop loss claim packets. Run queries, compiles eligibility data and submits claim packet. Audits stop loss positions by running queries and comparing to the accumulated claims in the billing system. Researches variances, document discrepancies and make appropriate adjustments. Responds to audit letters. Works with other areas including claims, marketing and managed care to obtain requested information. Tracks claims packet filing and MGU responses. Logs all submissions, audit letters receipts and responses in the tracking database/log. Provides manual monitoring of special stop loss scenarios including carved out pharmacy. Ensures the member's stop loss positions are properly tracked and updated. Performs complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions. Creates custom reports and spreadsheets based on customer inquiries. To Qualify for This Position, You Will Need: Required Education: Bachelor's in a job-related field Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience Required Work Experience: 3 years in accounting, auditing, billing, claims, membership, or finance. Required Skills and Abilities: 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. Required Software and Tools: Intermediate Microsoft Office skills including Access. We Prefer That You Have: Preferred Work Experience: Experience within self-funded insurance programs. Preferred Software and Other Tools: Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience. What We Can Do for You: 401(k) retirement savings plan with company match. Subsidized health plans and free vision coverage. Life insurance. Paid annual leave – the longer you work here, the more you earn. Nine paid holidays. On-site cafeterias and fitness centers in major locations. Wellness programs and healthy lifestyle premium discount. Tuition assistance. Service recognition. Incentive Plan. Merit Plan. Continuing education funds for additional certifications and certification renewal. 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 a 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. 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 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 with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit. Welcome Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. Join Us If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!

Responsibilities

The Stop Loss Analyst is responsible for submitting stop loss claim packets and responding to requests for additional information. This role involves tracking and monitoring claims, performing complex analysis, and generating queries to validate claim submissions.