Stop Loss Registered Nurse (W@H Anywhere)

Summary We are currently hiring for a Stop Loss Registered Nurse to join BlueCross BlueShield of South Carolina . In this role as a Stop Loss Registered Nurse, you will evaluate and manage catastrophic episodes of illness for underwriting and claims. Ensures that the insured is receiving the best medical care, but in the most cost-effective manner. Description Location: 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. What You’ll 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'll Need the Following: 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 hea