Sr Stoploss Claim Auditor
Not Disclosed•Full-TimeRemote
location_on7415, Commonwealth Avenue, Jacksonville, Duval County, Florida, 32220, United States
BlueCross BlueShield of South Carolina has been a cornerstone of the national landscape for over seven decades, with roots deeply embedded in the South Carolina community. As the largest insurance company in the state, we are also one of the nation's leading administrators of government contracts and operate one of the most sophisticated data processing centers in the Southeast. Through our diverse family of subsidiary companies, including iiSi, we build on various business strengths to deliver outstanding service to our customers.
We are dedicated to a philosophy of excellence and value a diverse and inclusive workplace 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.
As a member of the iiSi team, you will play a critical role in writing medical stop loss coverage across the nation. This position focuses on auditing and authorizing the reimbursement of specific medical stop loss claims while effectively mitigating client claims and providing excellent customer service.
In this remote, full-time role, you will analyze and adjudicate stop loss claims, recognizing cost mitigation opportunities and authorizing reimbursements within pre-set authority limits. You will initiate investigations, interpret plan language to identify experimental services and subrogation opportunities, and communicate effectively with carriers, vendors, and management. Additionally, you will generate claims system reports to adjust reserves and assist in the development of claim forms, internal auditing, and the training of claims auditors.
After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications. This process may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.
Please note that this position is not eligible for sponsorship now or in the future.
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment. We promote 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. As a federal contractor, we maintain affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans.
We are committed to providing reasonable accommodations to individuals with disabilities, pregnant individuals, and those needing accommodations for sincerely held religious beliefs. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. If you need special assistance or an accommodation while seeking employment, please contact mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480.
Work model: Remote
7415, Commonwealth Avenue, Jacksonville, Duval County, Florida, 32220, United States
Jacksonville, Florida
Skills: Managed Care, Reinsurance, Claims Experience, Stop Loss Claims, Subrogation, Claims Investigations, Claims Adjustments, Claims System Reports, Internal Auditing, Claims Auditors.
Education: Associate's degree required.
