Auditor, Sr Stoploss Claim

Internal Reference Number: R1049782
Summary Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service.Description
Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm CST and will be fully remote or hybrid if based near our Dallas office.

What You'll Do:

Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.

Initiate claims investigations and vendor referrals. Interpret plan language, and identify experimental services and subrogation opportunities. Identify need for follow-up on pended claims and resolution.

Communicate effectively with carriers, vendors, and management. Provide full claims service to both phone and written inquiries.

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.

To Qualify for This Position, You'll Need the Following:

Required Education: Associate's

Required Work Experience: 6 years of managed care or reinsurance claims experience.

We Prefer That You Have the Following:

Preferred Skills and Abilities:

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.

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.

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,... For full info follow application link.

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.