[Hiring] Stop Loss Registered Nurse @BlueCross BlueShield of South Carolina

Role Description

We are currently hiring for a Stop Loss Registered Nurse to join BlueCross BlueShield of South Carolina. In this role as a Stop Loss Registered Nurse, you will evaluate and manage catastrophic episodes of illness for underwriting and claims. Ensures that the insured is receiving the best medical care, but in the most cost-effective manner.

Location: This position is full-time (40 hours/week) Monday-Friday, working an 8-hour shift from 6:00am – 6:00pm and will be fully remote.

What You’ll Do:

• Facilitates cost estimates to the underwriters for new and renewal stop loss business.
• Consults with the underwriters on catastrophic episodes of illness.
• Provides case management oversight of managed care between the TPA and us.
• Review potential claim notices and excess claims received to determine setting reserves.
• Reviews potential claims notices from TPAs.
• Researches as necessary to evaluate cost containment and intervenes with the TPA.

Qualifications

• Required Education: Associates in a job-related field
• Degree Equivalency: Graduate of Accredited School of Nursing
• Required Work Experience: 10 years, 5 years clinical plus 5 years medical management experience.
• Required Skills and Abilities:
  • Working knowledge of word processing software.
  • Excellent verbal and written communication skills.
  • Ability to work independently, prioritize effectively, and make sound decisions.
  • Working knowledge of managed care and various forms of health care delivery systems.
  • Working knowledge of catastrophic claims cost, medical vendors, case management.
  • Demonstrated customer service, communication, and organizational skills.
  • Analytical or critical thinking skills.
  • Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
• Required Licenses and Certificates: Active RN licensure in state hired.

Requirements

• Experience working with a stop loss carrier and providing underwriting and claims with medical cost projects.
• Significant case managed and managed care experience.
• Experience with Medicare and/or Medicaid.
• HMO Reinsurance experience.
• Previous solutions-based consulting experience to partner effectively with a wide range of diverse clients.
• Ability to review and analyze large amounts of claims data and clinical information.
• Strong and supportive team player mentality.
• Willingness to learn new technology and materials.

Benefits

• 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, theaters, zoos, theme parks and more