Stop Loss Registered Nurse (W@H Anywhere)

BlueCross BlueShield of South Carolina; South Carolina; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare company is seeking a Stop Loss Registered Nurse to evaluate and manage catastrophic illness episodes. This fully remote position requires extensive clinical and medical management experience, along with strong communication and analytical skills. The role involves consulting with underwriters and overseeing case management. Join a diverse team that values inclusion and offers a comprehensive benefits package.

Benefits

Subsidized health, dental, and vision plans

401k with company match

Life Insurance

Paid Time Off (PTO)

Education Assistance

Service Recognition

National discounts on entertainment and attractions

Qualifications

• 10 years of work experience, including 5 years clinical and 5 years medical management experience.
• Active RN licensure in the state of employment.

Responsibilities

• Facilitate cost estimates for new and renewal stop loss business.
• Consult with underwriters on catastrophic episodes of illness.
• Provide case management oversight between the TPA and the company.

Skills

Communication

Analytical Skills

Customer Service

Organizational Skills

Education

Associates degree in a related field

Bachelor's degree in Nursing

Tools

Microsoft Office

Job description

Summary

We are currently hiring for a Stop Loss Registered Nurse to join BlueCross BlueShield of South Carolina. In this role, you will evaluate and manage catastrophic episodes of illness for underwriting and claims. Ensuring that the insured receives the best medical care in the most cost-effective manner.

Description

Location: This position is full-time (40 hours/week), Monday-Friday, from 8:00am – 5:00pm EST and will be fully remote.

What You’ll Do

1. Facilitate cost estimates to the underwriters for new and renewal stop loss business.
2. Consult with underwriters on catastrophic episodes of illness.
3. Provide case management oversight between the TPA and us.
4. Review potential claim notices and excess claims to determine reserve settings.
5. Research as necessary to evaluate cost containment and intervene with the TPA.

To Qualify For This Position, You'll Need The Following

• Associates degree in a related field; graduate of an accredited School of Nursing.
• 10 years of work experience, including 5 years clinical and 5 years medical management experience.
• Working knowledge of word processing software, Microsoft Office.
• Excellent verbal and written communication skills.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Knowledge of managed care, healthcare delivery systems, catastrophic claims, medical vendors, and case management.
• Demonstrated customer service, organizational, and analytical skills.
• Discretion in handling confidential information.
• Active RN licensure in the state of employment.

What We Prefer You To Have

• Bachelor's degree in Nursing.
• Over 10 years of experience as a medical staff nurse, with experience working with a stop loss carrier and in underwriting and claims related to medical costs.

Our Comprehensive Benefits Package Includes

Eligible employees can participate in benefits starting the first of the month following 28 days of employment, including:

• Subsidized health, dental, and vision plans
• 401k with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site amenities in major locations
• Education Assistance
• Service Recognition
• National discounts on entertainment and attractions

What We Can Do For You

We value diversity and inclusion, striving to be an employer where all employees can develop skills, advance careers, and contribute their unique abilities.

What To Expect Next

After application submission, our recruiting team will review your resume to verify qualifications, which may include a brief phone or email interview to discuss your resume and salary expectations.

Equal Employment Opportunity Statement

We are committed to nondiscrimination and equal opportunity in employment, providing reasonable accommodations for individuals with disabilities, pregnant individuals, and those with religious needs, on a case-by-case basis. For assistance, contact [e-mail] or call 800-288-2227, ext. 47480.

We participate in E-Verify and comply with pay transparency laws. More information is available on our policies and notifications.