Stop Loss Registered Nurse (W@H Anywhere)

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

Summary

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

Location: This position is full-time (40 hours/week) Monday-Friday, working an 8-hour shift from 6:00am – 6:00pm and will be fully remote.

What You’ll Do

• 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.

To Qualify for This Position, You\'ll Need the Following

Required Education

Associates in a job-related field

Degree Equivalency

Graduate of Accredited School of Nursing

Required Work Experience

10 years, 5 years clinical plus 5 years medical management experience.

Required Skills and Abilities

• Working knowledge of word processing software.
• Excellent verbal and written communication skills.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Working knowledge of managed care and various forms of health care delivery systems.
• Working knowledge of catastrophic claims cost, medical vendors, case management.
• Demonstrated customer service, communication, and organizational skills.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.

Required Software and Tools

Microsoft Office.

Required Licenses and Certificates

Active RN licensure in state hired.

What We Prefer You to Have

• Experience working with a stop loss carrier and providing underwriting and claims with medical cost projects.
• Significant case management and managed care experience.
• Experience with Medicare and/or Medicaid.
• HMO Reinsurance experience.
• Previous solutions- based consulting experience to partner effectively with a wide range of diverse clients.
• Ability to review and analyze large amounts of claims data and clinical information.
• Strong and supportive team player mentality.
• Willingness to learn new technology and materials.

Work Environment

Fully remote anywhere in the United States of America. About 25% of travel to visit clients or participate in team meetings or conferences (travel expenses will be reimbursed).

Our Comprehensive Benefits Package Includes the Following

• Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Pay Range Information

• Range Minimum $70, 715.00
• Range Midpoint $105,463.50
• Range Maximum $140,212.00
• Pay Transparency Statement: Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Welcome

Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.

Join Us If you're ready to join in a diverse company with secure, community roots and an innovative future,