Stop Loss Accounting Analyst (Work from Home)

BlueCross BlueShield of South Carolina; South Carolina; Remote; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare insurance provider is seeking a Stop Loss Accounting Analyst to work remotely. The role involves preparing and auditing stop-loss claims, requiring a Bachelor’s degree and three years of relevant finance experience. Strong skills in data analysis and communication are essential. The position offers a comprehensive benefits package and promotes diversity and inclusion.

Benefits

401(k) with company match

Health plans and vision coverage

Paid annual leave

Tuition assistance

Qualifications

• Bachelor’s in a job-related field or four years of related work experience.
• Three years in accounting, auditing, billing, claims, membership, or finance.
• Ability to compile information, perform research, analyze data.

Responsibilities

• Prepare and file 50% and 100% stop loss claim packets.
• Audit stop loss positions by running queries and comparing to the billing system.
• Respond to audit letters and collaborate with claims and marketing.

Skills

Data analysis

Customer service

Organizational skills

Communication

Attention to detail

Education

Bachelor's degree in a job-related field

Tools

Microsoft Office

Access

Job description

Overview

Stop Loss Accounting Analyst (Work from Home) – Remote in Richland County, SC, United States. This full-time role is with BlueCross BlueShield of South Carolina. The position requires a Bachelor’s degree or equivalent experience and is open to candidates with relevant accounting/finance backgrounds.

Job Responsibility

Summary: Planned Administrators (PAI) is a subsidiary of BCBSSC that has served self-administered health plans for the last 40 years. Join our team handling stop-loss claims. Stop loss is insurance coverage where the policy pays after medical claims exceed a pre-determined amount. This role will utilize data analysis skills to identify stop-loss issues, perform root cause analysis, and present viable solutions. Responsibilities include submitting stop loss claim packets, responding to requests for information, and tracking/monitoring claims. Complex analyses are performed and queries are generated to file and validate claim submissions.

Work Location and Hours

• Work Hours: 8:00 am to 5:00 pm, Monday through Friday.
• Position is work from home; must have high-speed internet (non-satellite) and a private home office.
• Travel to the Columbia, SC office for trainings and meetings is required. Candidates residing within a two-hour drive of the Columbia, SC office are preferred.

What You Will Do

• Prepare and file 50% and 100% stop loss claim packets. Run queries, compile eligibility data, and submit claim packets.
• Audit stop loss positions by running queries and comparing to the billing system; research variances, document discrepancies, and make adjustments.
• Respond to audit letters. Collaborate with claims, marketing, and managed care to obtain requested information.
• Track claims packet filing and MGU responses. Log submissions, audit letters, receipts, and responses.
• Provide manual monitoring of special stop loss scenarios including carved-out pharmacy. Ensure stop loss positions are properly tracked and updated.
• Perform complex reviews of claims data when the stop loss system does not accurately accumulate positions. Create custom reports and spreadsheets based on customer inquiries.

Qualifications

• Required Education: Bachelor’s in a job-related field or four years of related work experience, or an Associate’s degree with two years of related work experience.
• Required Experience: Three years in accounting, auditing, billing, claims, membership, or finance.
• Required Skills and Abilities: Ability to compile information, perform research, analyze data; strong customer service and organizational skills; excellent verbal and written communication; initiative and ability to meet deadlines; attention to detail.
• Required Software and Other Tools: Intermediate Microsoft Office skills including Access.

Preferred Qualifications

• Preferred Work Experience: Experience within self-funded insurance programs, stop-loss, and/or accounting.
• Preferred Software/Tools: AMMS or Quicklink claims processing system.

What We Can Do for You

BlueCross BlueShield of South Carolina values diversity and inclusion and offers a comprehensive benefits package, including: 401(k) with company match; health plans and vision coverage; life insurance; paid annual leave; nine paid holidays; on-site cafeterias and fitness centers in major locations; wellness programs and a healthy lifestyle premium discount; tuition assistance; service recognition.

What to Expect Next

After submitting your application, our recruiting team will review your resume to verify qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will interview the most qualified candidates. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. For accommodations, contact [e-mail] or call 1-800-288-2227, ext. 47480.

Equal Employment Opportunity

BlueCross BlueShield of South Carolina and our subsidiary companies maintain nondiscrimination in employment and are committed to equal opportunities in all phases of the employment process in accordance with applicable federal, state, and local laws. We provide reasonable accommodations to individuals with disabilities. For accommodation requests, please contact the number above.

Keywords: Closed Date 2025-10-29