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SalarySummary
Planned Administrators (PAI) is a subsidiary of BCBSSC that has been serving self-administered health plans for the last 40 years. Join our team handling stop-loss claims. Stop loss is a type of insurance coverage where the policy only pays after medical claims exceed a pre-determined amount.This newly created position will allow you to utilize your critical data analysis skills to identify stop-loss issues, perform root cause analysis and present viable solutions.
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
Work Location and Hours:
- Work Hours: 8:00 am to 5:00 pm Monday through Friday.
- Position will be Work from Home. To Work from Home, you must have high-speed internet (non-satellite) and a private home office.
- Travel to the Columbia, SC office for trainings and meetings is required. Therefore, candidates residing within a two-hour drive of our Columbia, SC office are preferred.
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.
What You Need to Qualify:
- Required Education: Bachelor's in a job-related field OR four years job-related work experience OR Associate's and two years job-related work experience.
- Required Experience: Three 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: Intermediate Microsoft Office skills including Access.
What We Prefer You Have:
- Preferred Work Experience: Experience within a self-funded insurance programs, stop-loss and/or accounting experience.
- Preferred Software and Other Tools: Experience with AMMS or Quicklink claims processing system.
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 access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
Our comprehensive benefits package includes:
- 401(k) retirement savings plan with company match
- Fantastic 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 a healthy lifestyle premium discount
- Tuition assistance
- Service recognition
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. Management will be conducting interviews with the most qualified candidates.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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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 mycareer.help@bcbssc.com or call 1-800-288-2227, 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.
