Stop Loss Registered Nurse (W@H Anywhere)

This position is full-time (40 hours/week) Monday-Friday, working an 8-hour shift from 6:00am – 6:00pm and will be fully remote.

• →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.

• Required Education: Associates in a job-related field
• Degree Equivalency: Graduate of Accredited School of Nursing
• Required Work Experience: 10 years, 5 years clinical plus 5 years medical management experience.
• Required Skills and Abilities: 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 Licenses and Certificates: Active RN licensure in state hired.

• Experience working with a stop loss carrier and providing underwriting and claims with medical cost projects.
• Significant case management and managed care experience.
• Experience with Medicare and/or Medicaid.
• HMO Reinsurance experience.
• Previous solutions- based consulting experience to partner effectively with a wide range of diverse clients.
• Ability to review and analyze large amounts of claims data and clinical information. 
• Strong and supportive team player mentality.
• Willingness to learn new technology and materials.

• Fully remote anywhere in the United States of America.
• About 25% of travel to visit clients or participate in team meetings or conferences (travel expenses will be reimbursed).

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

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 our recruiter to verify resume specifics and salary requirements.

 $70, 715.00

 $140,212.00

Please note that this range represents the pay range for this and other positions that fall into this pay grade.  Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity. 

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 disabilities and 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 mycareer.help@bcbssc.com or call 800-288-2227, 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. Here's more information.

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