Stop Loss Accounting Analyst- PAI
Stop Loss Accounting Analyst- PAI
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Job Description
Summary
Planned Administrators (PAI) is a subsidiary of BCBSSC that has been serving self-administered health plans for the last 40 years. Join our team handling stop-loss claims. Stop loss is a type of insurance coverage where the policy only pays after medical claims exceed a pre-determined amount.This newly created position will allow you to utilize your critical data analysis skills to identify stop-loss issues perform root cause analysis and present viable solutions.
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.
Description
Logistics:
This position is full time (40 hours/week) Monday-Friday with typical work hours between 8:00 am 5:00 pm in a hybrid setting working from home and onsite at the 17 Technology Circle Columbia SC 29203 location. To work from home you must have high-speed internet (non-satellite) and a private home office.
What You Will Do:
Prepares and files 50% and 100% stop loss claim packets. Run 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 make 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 audit letters receipts and responses in the tracking database/log.
Provides manual monitoring of special stop loss scenarios including carved out pharmacy. Ensures the members 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.
To Qualify for This Position You Will Need:
Required Education: Bachelors in a job-related field
Degree Equivalency: 4 years job related work experience or Associates and 2 years job related work experience
Required Work 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 Tools: Intermediate Microsoft Office skills including Access.
We Prefer That You Have:
Preferred Work Experience: Experience within self-funded insurance programs stop-loss and/or accounting experience
Preferred Software and Other Tools: Experience with AMMS or Quicklink claims processing system
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.
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 a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.
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 or call 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.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.
Some states have required notifications. Heres more information.
Required Experience:
IC
Employment Type
Full-Time
