Stop Loss Accounting Analyst

Summary

We are currently hiring for a Stop Loss Accounting Analyst to join BlueCross BlueShield of South Carolina. In this role as Stop Loss Accounting Analyst, you will be 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.

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 have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are 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 committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description

Logistics

This position is full time (40 hours/week) Monday-Friday 8:00-4:30 at Percival Road.

What You Will 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.

Perform complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions. Create 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 OR 4 years job related work experience OR Associate's and 2 years job related 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 Other Tools: Microsoft Office including Access

What We Prefer:

Prior billing, membership, or accounting work experience.

Experience with AMMS claims processing system, membership and PFAB claims billing systems.

Proficiency with Microsoft Excel and Access. Strong knowledge and use of the Group Library Cloud.

Intermediate working knowledge in Microsoft Office suite.

Able to work in a fast pace working environment with strict time lines for specific assigned tasks.

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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

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 or call, 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.

R1036573