Summary
 

We are currently hiring for a Stop Loss Accounting Analyst to join BlueCross BlueShield of South Carolina. In this role as Stop Loss Accounting Analyst, you will be 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.

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description
 

Logistics

This position is full-time (40 hours/week) Monday-Friday 8:00am-4:30pm in Columbia, SC at our Percival Rd location.

What You Will 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 Will Need:

• Bachelor's in a job-related field OR 4 years job-related work experience OR Associate's and 2 years job-related work experience
• 3 years in accounting, auditing, billing, claims, membership, or finance.
• 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.
• Microsoft Office knowledge including Excel (understanding of formulas, functions, data analysis tools like PivotTables)

What We Prefer:

• Prior experience in billing, banking, finance, queries, excel, macros, membership, or accounting work experience.
• Experience with AMMS claims processing system, membership and PFAB claims billing systems.
• Strong knowledge and use of the Group Library Cloud.
• Intermediate working knowledge in Microsoft Office suite.
• Able to work in a fast-paced working environment with strict deadlines for specific assigned tasks.

What We Can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.

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