Remote Stop-Loss RN - Case Management & Underwriting

Southcarolinablues; South Carolina; Hybrid; USD 71,000 - 140,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off

Job summary

BlueCross BlueShield of South Carolina is seeking a Stop Loss Registered Nurse to manage catastrophic illness episodes for underwriting and claims. This full-time, fully remote role supports cost-effective care while ensuring high-quality patient outcomes.

The RN will work with underwriters, TPAs, and care teams from a home office across the United States. Qualifications include an RN license, an associate degree in a related field, and 10 years of experience (5 clinical, 5 medical management).

Qualifications

• Associates degree required; RN licensure in state of hire.
• Graduate of an accredited school of nursing with eligible licensure.
• 10+ years total experience: 5 years clinical plus 5 years medical management.

Responsibilities

• Facilitates cost estimates to underwriters for new and renewal stop loss business.
• Consults with underwriters on catastrophic episodes of illness.
• Provides case management oversight between the TPA and our company.
• Reviews potential claim notices and excess claims to determine reserves.
• Reviews claims notices from TPAs and evaluates cost containment options.
• Researches and intervenes with the TPA on cost containment opportunities.

Skills

Verbal and written communication

Independent work

Prioritization

Managed care knowledge

Analytical thinking

Discretion with confidential info

Education

Associates degree in a related field

RN licensure (state of hire)

Accredited nursing program graduate

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Stop Loss Registered Nurse to manage catastrophic illness episodes for underwriting and claims. This full-time, fully remote role supports cost-effective care while ensuring high-quality patient outcomes.

The RN will work with underwriters, TPAs, and care teams from a home office across the United States. Qualifications include an RN license, an associate degree in a related field, and 10 years of experience (5 clinical, 5 medical management).