Analyst, Stop Loss Accounting

BlueCross BlueShield of South Carolina•Columbia, SC

4d•Onsite

About The Position

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

Bachelors in a job-related field
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 including Access.

Nice To Haves

Experience within a self-funded insurance programs.
Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience.

Responsibilities

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.