Remote Stop-Loss RN: Underwriting & Claims Strategist

001 BlueCross and BlueShield of South Carolina; South Carolina; Hybrid; USD 71,000 - 140,000; Full time

Benefits offered by this job

Health and dental coverage

401k with company match

Paid Time Off (PTO)

Life Insurance

Job summary

BlueCross BlueShield of South Carolina is hiring a Stop Loss Registered Nurse to evaluate and manage catastrophic illness episodes for underwriting and claims, ensuring high quality care at cost-effective rates. This full-time position is fully remote in the United States, with a 40-hour workweek, Monday–Friday, 6:00am–6:00pm.

You will assist underwriters with cost estimates, provide case management oversight between the TPA and BCBS SC, review potential claims, and research cost containment

Qualifications

• Associates in a job-related field.
• Graduate of Accredited School of Nursing.
• Active RN licensure in state hired.

Responsibilities

• 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.

Skills

Word processing

Communication

Independent work

Managed care

Catastrophic costs

Case management

Customer service

Analytical thinking

Confidentiality

Education

Associates in a job-related field

Graduate of Accredited School of Nursing

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Stop Loss Registered Nurse to evaluate and manage catastrophic illness episodes for underwriting and claims, ensuring high quality care at cost-effective rates. This full-time position is fully remote in the United States, with a 40-hour workweek, Monday–Friday, 6:00am–6:00pm.

You will assist underwriters with cost estimates, provide case management oversight between the TPA and BCBS SC, review potential claims, and research cost containment