Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Responsible for submitting stop loss claim packets and responding to any requests for additional information. Additionally, the claims must be tracked and monitored. Complex analysis is performed and queries are generated to file and validate the claim submissions.

Logistics: BlueCross BlueShield of South Carolina.  

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 7:30AM-4:30PM. This role is located at 4101 Percival Road, Columbia, SC 29229. 

What You'll Do:

• Prepare and file 50% and 100% stop loss claim packets. Run queries, compile eligibility data and submit claim packet.

• Audit stop loss positions by running queries and comparing to the accumulated claims in the billing system. Research variances, document discrepancies and make appropriate adjustments.

• Respond to audit letters. Work with other areas including claims, marketing and managed care to obtain requested information.

• Track claims packet filing and MGU responses. Log all submissions, audit letters receipts and responses in the tracking database/log.

• Provide manual monitoring of special stop loss scenarios including carved out pharmacy. Ensure the member's stop loss positions are properly tracked and updated.

• Perform complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions. Create custom reports and spreadsheets based on customer inquiries.

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

• Required Education: Bachelors in a job-related field

• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

• Required Experience: 3 years in accounting, auditing, billing, claims, membership, or finance.

• Required Skills and Abilities: Ability to compile information, perform research and analyze data. Strong customer service and organizational skills.

• Excellent verbal and written communication skills. Ability to take initiative and meet deadlines. Attention to detail.

• Required Software and Other Tools: Microsoft Office including Access.

We Prefer That You have the Following:

• Experience within a self-funded insurance programs.

• Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience.

Our Comprehensive Benefits Package Includes the Following: 

We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program 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 

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