Summary

We are currently hiring for a Stop Loss Registered Nurse to join BlueCross BlueShield of South Carolina. In this role as Stop Loss Registered Nurse you will evaluate and manage catastrophic episodes of illness for underwriting and claims. You will also ensure that the insured is receiving the best medical care, but in the most cost effective manner.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

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

Logistics
This position is full time (40 hours/week) Monday-Friday and will be fully remote (W@H).

Description

What You Will Do:

• Facilitates cost estimates to the underwriters for new and renewal stop loss business.
• Consults with the underwriters on catastrophic episodes of illness.
• Provides case management oversight of managed care between the TPA and us.
• Review potential claim notices and excess claims received to determine setting reserves.
• Reviews potential claims notices from TPAs.
• Researches as necessary to evaluate cost containment and intervenes with the TPA.

To Qualify for This Position, You Will Need:

• Associate Degree Nursing or Graduate of accredited School of Nursing.
• 10 years , 5 years clinical plus 5 years medical management experience.
• Working knowledge of word processing software.
• Excellent verbal and written communication skills.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Working knowledge of managed care and various forms of health care delivery systems.
• Working knowledge of catastrophic claims cost, medical vendors, case management.
• Demonstrated customer service, communication, and organizational skills.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
• Required License and Certificate: Active RN licensure in state hired.

What We Prefer:

• Bachelor's degree-Nursing
• 10+ years-as a medical staff nurse, experience working with a stop loss carrier and providing underwriting and claims with medical cost projects.

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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.