Analyst, Stop Loss Accounting

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: BlueCross BlueShield of South Carolina.

Logistics

Location: Full-time (40-hours/week) Monday-Friday in a typical office environment. Schedules: 8-hour shift scheduled during our normal business hours of 7:30AM-4:30PM. This role is located at 4101 Percival Road, Columbia, SC 29229.

What You'll Do

• Prepare and file 50% and 100% stop loss claim packets.
• Run queries, compile eligibility data and submit claim packet.
• Audit stop loss positions by running queries and comparing to the accumulated claims in the billing system.
• Research variances, document discrepancies and make appropriate adjustments.
• Respond to audit letters.
• Work with other areas including claims, marketing and managed care to obtain requested information.
• Track claims packet filing and MGU responses.
• Log all submissions, audit letters receipts and responses in the tracking database/log.
• Provide manual monitoring of special stop loss scenarios including carved out pharmacy.
• Ensure the member's stop loss positions are properly tracked and updated.
• Create custom reports and spreadsheets based on customer inquiries.

What You'll Need

• Education: Bachelors in a job-related field or equivalent experience.
• Experience: 3 years in accounting, auditing, billing, claims, membership, or finance.
• 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.
• Software and Tools: Microsoft Office including Access.

Preferred Experience

We prefer candidates with experience within a self-funded insurance programs. Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience.

What We Can Do For You

We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program 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.

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.