Senior Stoploss Claim Auditor (Remote)

BlueCross BlueShield of South Carolina; Orlando (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a Senior Stoploss Claim Auditor for a remote role in the United States. This position involves auditing and authorizing medical stop-loss claims, providing excellent customer service, and mitigating claims effectively. The ideal candidate will have relevant claims experience and strong analytical skills. Join a team committed to excellence in service and product as you contribute to the success of the organization.

Benefits

Health, dental, vision plans

401k with company match

Life insurance

PTO

Education assistance

Discounts

Qualifications

• Six years of relevant claims experience required.
• Preferred: Prior stop loss insurance experience.

Responsibilities

• Analyze and adjudicate stop loss claims and authorize claims below authority limits.
• Communicate effectively with carriers, vendors, and management.
• Develop and review stop loss claim forms and assist with audits.

Skills

Customer service

Organization

Critical thinking

Analytical skills

Proficiency in Microsoft Office

Education

Associate degree

Medical/reinsurance claims experience

Job description

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Summary
This role is responsible for auditing and authorizing reimbursement of specific medical stop-loss claims. The role effectively mitigates client medical stop-loss claims and provides excellent customer service.

About the Company
Founded in 1991, International Specialty Underwriters, Inc. (ISU) provides exceptional service to the stop loss industry, including claims, underwriting, marketing, and administration. ISU became part of Companion Life Insurance Company in 2008. Our commitment to Excellence in Service, People, and Product guides our success. We pride ourselves on our detailed Carrier Business Model and over 30 years of industry experience among our management team.

Job Details
Logistics:

• This is a full-time (40 HPW) remote position within the United States.
• Travel to training and limited client site visits are required.

Responsibilities

1. Analyze and adjudicate stop loss claims, request reimbursements, recognize cost mitigation opportunities, and authorize claims below authority limits.
2. Initiate investigations, interpret plan language, and identify subrogation opportunities.
3. Follow-up on pended claims and resolve issues.
4. Communicate effectively with carriers, vendors, and management.
5. Maintain claims reports for reserves, pending/backlog claims, and renewal data.
6. Develop and review stop loss claim forms, assist with audits, and train claims staff.
7. Remote work with travel as needed.

Qualifications

• Associate degree or two years of medical/reinsurance claims experience.
• Six years of relevant claims experience.
• Preferred: Prior stop loss insurance experience, excellent customer service skills, medical terminology knowledge.
• Skills: Customer service, organization, critical thinking, analytical skills, proficiency in Microsoft Office.
• Knowledge of group insurance, managed care, medical claims, COB, Medicare, HIPAA, CPT, ICD-9, and benefit plans.
• Ability to work independently and influence others.

Benefits

• Health, dental, vision plans
• 401k with company match
• Life insurance
• PTO, education assistance, discounts

Work Environment
Remote role with travel as needed.

EEO Statement
BlueCross BlueShield of South Carolina is an equal opportunity employer. We provide reasonable accommodations for individuals with disabilities or religious beliefs. For accommodations, contact [e-mail] or call 800-288-2277, ext.47480.