Stop Loss Registered Nurse (W@H Anywhere)

BlueCross and BlueShield of South Carolina; United States; Remote; USD 71.000 - 140.000; Vollzeit

Benefits dieser Stelle

Health plan benefits

401(k) with company match

Paid time off

Zusammenfassung

BlueCross BlueShield of South Carolina is seeking a Stop Loss Registered Nurse to evaluate and manage catastrophic illness episodes for underwriting and claims, ensuring cost-effective, high-quality patient care.

This full-time, remote role requires RN licensure, 10 years of experience (5 clinical + 5 medical management), and strong communication and analytical skills. Travel up to 25% and robust benefits offered.

Qualifikationen

• Associates degree in a related field.
• Graduate of Accredited School of Nursing with active RN licensure.
• 10 years of work experience: 5 clinical + 5 medical management.
• Excellent verbal and written communication skills.
• Ability to work independently, prioritize, and make sound decisions.
• Knowledge of managed care, catastrophic claims, and medical vendors.
• Strong customer service, communication, and organizational skills.

Aufgaben

• Facilitates cost estimates to underwriters for new and renewal stop loss business.
• Consults with underwriters on catastrophic illness episodes.
• Provides case management oversight of managed care between TPA and the company.
• Reviews potential claim notices and determines reserves.
• Reviews claims notices from TPAs.
• Researches data to evaluate cost containment and intervenes with the TPA.

Kenntnisse

Word processing

Communication skills

Independent work

Analytical thinking

Discretion

Ausbildung

Associate degree in a job-related field

RN licensure from accredited nursing school

Tools

Microsoft Office

Jobbeschreibung

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

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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.

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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 disabilitiesand 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] 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.

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