Summary
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.
To Qualify for This Position, You'll Need the Following
- 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.
What We Prefer You to Have
- Experience working with a stop loss carrier and providing underwriting and claims with medical cost projects.
- Significant case management 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.
Work Environment
- Fully remote anywhere in the United States of America.
- About 25% of travel to visit clients or participate in team meetings or conferences (travel expenses will be reimbursed).
Pay Range Information
Range Minimum $70, 715.00 Range Midpoint $105,463.50 Range Maximum $140,212.00