Analyst, Stop Loss Accounting

BlueCross BlueShield of South Carolina • Columbia, SC

1d • Hybrid

About The Position

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.

Requirements

• 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.

Nice To Haves

• Experience within a self-funded insurance programs
• Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience.
• Microsoft Office knowledge including Excel (understanding of formulas, functions, data analysis tools like PivotTables).

Responsibilities

• Prepares and files 50% and 100% stops loss claim packets.
• Runs queries, compiles eligibility data and submits claim packet.
• Audits stop loss positions by running queries and comparing to the accumulated claims in the billing system.
• Researches variances, document discrepancies and makes appropriate adjustments.
• Responds to audit letters.
• Works with other areas including claims, marketing and managed care to obtain requested information.
• Tracks claims packet filing and MGU responses.
• Logs all submissions, audits letters receipts and responses in the tracking database/log.
• Provides manual monitoring of special stop loss scenarios including carved out pharmacy.
• Ensures the member's stop loss positions are properly tracked and updated.
• Performs complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions.
• Creates custom reports and spreadsheets based on customer inquiries.

Benefits

• 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 This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees