Technician, Auditing/Stoploss

Bluecross Blueshield Of South Carolina Columbia , SC 29209

Posted 3 months ago

Summary

Responsible for submitting stop loss claims to our reinsurance carriers. Coordinates with claims and membership to obtain required supporting documentation for stop loss reimbursements. Maintains/provides status updates via reporting, logs, and the stop loss database of all outstanding submissions.

Description

  • 65% Monitors aggregate and specific claims experience by use of specific analysis, loss ratio reporting, stop loss database and spreadsheets. Ensures prompt identification and accurate submission for stop loss recovery filings.
  • 20% Receives and processes stop loss reimbursements prior to forwarding to the client. Corresponds with the stop loss carrier to identify, analyze, and resolve any pending issues regarding outstanding stop loss submissions.
  • 15% Maintains and provides status updates by use of reporting, logs, and the stop loss database of all outstanding submissions.

Required Work Experience:

  • Three years of membership/billing/accounts and/or audit/compliance experience.

Required Education:

  • Associate Degree OR
  • Two years of related work experience.

Preferred:

  • Experience with AMMS claims processing system, membership & PFAB claims billing systems, and DB2/Easytrieve experience.

  • Proficiency with Microsoft Excel and Access.

  • Prior stop loss auditing and/or claims billing experience.

  • Strong knowledge and use of the Group Library.

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.


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Technician, Auditing/Stoploss

Bluecross Blueshield Of South Carolina