Ourhrconnect
Senior Stop Loss Claims Auditor
Columbia, South Carolina · Senior · Contract
Sponsorship not specifiedDetected 5 days ago
AuditingCommunication
About the role
- 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.
Responsibilities
- 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.
Requirements
- 2 years of job-related work experience
- 6 years of managed care or reinsurance claims experience.
- We Prefer That You Have the Following:
- Degree Equivalency: 2 years of job-related work experience
- Required Work Experience: 6 years of managed care or reinsurance claims experience.
- Some states have required notifications.
Nice to have
- Preferred Skills and Abilities:
Skills
- 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
Compensation
- 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.
Benefits
- Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier.
- Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.
- Required Education: Associate's
- Our Comprehensive Benefits Package Includes the Following:
- We offer our employees great benefits and rewards.
- You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
- Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
Equal opportunity
- 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.
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This listing is sourced directly from Ourhrconnect's careers page and normalized into a canonical job model.