BlueCross BlueShield of South Carolina

Chronic Disease Coach - Registered Nurse (W@H SC, NC, or GA)

BlueCross BlueShield of South Carolina · Full Time · 9 hours ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Provide personalized guidance, education, and support to members for chronic disease prevention and healthy promotion. Assess member needs, coordinate action plans, and serve as a member advocate to help individuals achieve optimal health goals.

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Premium Coordinator

BlueCross BlueShield of South Carolina · Full Time · 14 hours ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Premium Coordinator manages stop-loss premium activity, including application processing and payment reconciliation. They serve as the primary coordination point between financial operations and external partners like TPAs and producers.

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Senior Stoploss Claim Auditor

BlueCross BlueShield of South Carolina · Full Time · a day ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $53320 - $101K per year ⭐ 5-10 yrs exp 💼 Finance

Audit and authorize reimbursement for specific and aggregate medical stop loss claims while mitigating costs. This role involves interpreting plan language, conducting claims investigations, and maintaining system reports to adjust reserves.

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Senior Group Underwriter

BlueCross BlueShield of South Carolina · Full Time · 2 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $57636 - $109K per year ⭐ 5-10 yrs exp 💼 Finance

Rates and designs benefits for the largest and most complex groups while serving as the primary contact for stop loss vendors. Responsibilities include determining risk acceptability, generating proposals, and training less experienced underwriters.

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Senior Medical Reviewer

BlueCross BlueShield of South Carolina · Full Time · 3 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Acts as a Team Lead for specialty programs, providing guidance, training, and support to staff in medical review and utilization management. Monitors workflows, resolves technical claims issues, and ensures quality healthcare services are provided.

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Business Test Analyst I

BlueCross BlueShield of South Carolina · Full Time · 3 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Coordinates and performs testing for major system enhancements by creating test matrices and executing test cases. Acts as a liaison between operations and Information Systems to resolve technical production issues.

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Physical Medicine and Rehabilitation Medical Director

BlueCross BlueShield of South Carolina · Full Time · 3 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $206K - $413K per year ⭐ 5-10 yrs exp 💼 Healthcare

Provides administrative oversight to medical staff and analyzes utilization data to guide medical policies. Acts as a resource for providers and researches new medical procedures and technology.

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Job Posting Title RN Appeals Analyst Medicare Part B - CGS

BlueCross BlueShield of South Carolina · Full Time · 5 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Appeals Analyst researches complex appeal and retrospective review requests to determine if services meet medical necessity guidelines. They are responsible for documenting decisions accurately and timely in compliance with applicable regulations and standards.

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Associate Actuary

BlueCross BlueShield of South Carolina · Full Time · 6 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Finance

Maintains actuarial reporting systems and performs profitability analysis to determine appropriate rates for various lines of business. Prepares regulatory rate filings and determines reserves for reported and unreported liabilities.

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Lead Auditor, Medicare

BlueCross BlueShield of South Carolina · Full Time · 7 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $30227.5 - $60588 per year ⭐ 5-10 yrs exp 💼 Finance

Coordinates and completes audit reviews, focusing on operational controls, compliance, and risk management activities. Mentors staff and communicates audit results and corrective actions to management.

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Auditor III

BlueCross BlueShield of South Carolina · Full Time · 7 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Finance

The role involves conducting a full range of financial, compliance, and operational audits to evaluate internal controls and identify business risks. The Auditor III also drafts recommendations for executive management to improve processes and prevent fraud.

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Appeals Specialist (CGS Admin)

BlueCross BlueShield of South Carolina · Full Time · 8 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Perform non-medical reviews and process redetermination letters to ensure timeliness and accuracy. Prepare unit reports, analyze workloads, and update departmental documentation using various software tools.

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Appeals Specialist - (CGS Admin)

BlueCross BlueShield of South Carolina · Full Time · 8 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Perform non-medical reviews and process redetermination letters while ensuring accuracy and timeliness. Analyze workloads, prepare unit reports, and update departmental documentation and legal inquiries.

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RN Case Management Coordinator

BlueCross BlueShield of South Carolina · Full Time · 12 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The coordinator provides active care management by assessing service needs, developing action plans, and monitoring outcomes to improve client safety and quality of life. They perform medical and behavioral reviews to ensure coverage within benefit guidelines and advocate for members through education and coordination.

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Senior Underwriter - Stop Loss Focus

BlueCross BlueShield of South Carolina · Full Time · 12 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $57636 - $109K per year ⭐ 5-10 yrs exp 💼 Finance

The role involves rating and designing benefits for large, complex groups and serving as the primary contact for stop loss vendors. Responsibilities include determining risk acceptability, generating proposals, and training less experienced underwriters.

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Senior Stop Loss Underwriter

BlueCross BlueShield of South Carolina · Full Time · 13 days ago

BlueCross BlueShield of South Carolina

🌎 Trinidad and Tobago, United States 💵 $82832 - $163K per year ⭐ 5-10 yrs exp 💼 Finance

Underwrite a profitable book of business in the employer stop loss marketplace by setting rates and coverage terms. Manage client relations and service existing business to maintain targeted profitability and loss ratios.

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RN Concierge Care Manager

BlueCross BlueShield of South Carolina · Full Time · 19 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Provide high-touch concierge care management for members with complex conditions such as high-risk maternity, cancer, and behavioral health. Coordinate clinical services with external providers and develop individualized care plans to improve quality of life and cost-effectiveness.

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Sr Stoploss Claim Auditor-2

BlueCross BlueShield of South Carolina · Full Time · 19 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $51107 - $97729 per year ⭐ 5-10 yrs exp 💼 Finance

Analyze and adjudicate medical stop loss claims to authorize reimbursements and mitigate costs. Perform claims investigations, maintain system reports, and assist in the training and auditing of other claims auditors.

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Sr Stoploss Claim Auditor-1

BlueCross BlueShield of South Carolina · Full Time · 19 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $51107 - $97729 per year ⭐ 5-10 yrs exp 💼 Finance

Analyze and adjudicate medical stop loss claims to authorize reimbursements and mitigate costs. Manage claims investigations, maintain system reports, and provide training and auditing for other claims auditors.

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Senior Medical Review Director

BlueCross BlueShield of South Carolina · Full Time · 2 months ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 10+ yrs exp 💼 Healthcare

The Senior Medical Review Director leads and oversees the administration of Medical Review and Prior Authorization programs to ensure compliance with CMS guidelines. This role develops strategic plans, manages budgets, and serves as a liaison between internal and external stakeholders to optimize operational performance.

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Accounting Technician III

BlueCross BlueShield of South Carolina · Full Time · 8 months ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Finance

Under general supervision, the Accounting Technician III performs a variety of routine to complex clerical and accounting functions. Responsibilities include inventory balancing, reconciliations, processing disbursements and deposits, and generating refund request letters.

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