Job Responsibilities : Registered Remote Nurse Jobs | Registered Nurse
Company : BlueCross BlueShield
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’ve 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 dedicated to the same philosophy, consider joining our team!
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:
- Associate Degree Nursing or Graduate of accredited School of Nursing.
- Ten years total experience with, five years of required experience as clinical plus the other five years as 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.
- Microsoft Office.
- Active RN licensure in state hired.
We prefer that you have:
- Bachelor’s degree-Nursing
- Ten plus 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:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
Our comprehensive benefits package includes:
- 401(k) retirement savings plan with company match
- Fantastic 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 a healthy lifestyle premium discount
- Tuition assistance
- Service recognition
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 our 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.