Analyst, Stop Loss Accounting

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
 

Position Purpose:

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.
Logistics: This position is full-time (40 hours/week) Monday-Friday, 8:00 am-4:30 pm onsite at 4101 Percival Road, Columbia, SC 29229, with an option of work from home once 90-day training is complete, and performance standards are being met.

What You Will Do:

• Prepares and files 50% and 100% stops loss claim packets. Runs 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 makes 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, audits 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 The Following:

• 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.

We Prefer That You Have The Following:

• Preferred Work Experience: Experience within a self-funded insurance programs

• Preferred Software and Other Tools: Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience. Microsoft Office knowledge including Excel (understanding of formulas, functions, data analysis tools like PivotTables).

• Work Environment: Typical office environment

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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

What We Can Do for You:

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.

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.

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 [email protected] 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.

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