Stop Loss Accounting Analyst- PAI

About the position

Planned Administrators (PAI), a subsidiary of BlueCross BlueShield of South Carolina, has been a trusted partner in managing self-administered health plans for over 40 years. We are currently seeking a Stop Loss Accounting Analyst to join our team, focusing on the critical area of stop-loss claims. This newly created position is designed for individuals who possess strong data analysis skills and are eager to tackle complex challenges in the insurance domain. The primary responsibility of this role is to identify stop-loss issues, conduct thorough root cause analyses, and present viable solutions to enhance our claims processing efficiency. In this role, you will be responsible for preparing and submitting stop-loss claim packets, which include both 50% and 100% claims. You will run queries to compile eligibility data and ensure that all claims are accurately filed and validated. Additionally, you will audit stop-loss positions by comparing them to accumulated claims in our billing system, researching any variances, documenting discrepancies, and making necessary adjustments. Your ability to communicate effectively with various departments, including claims, marketing, and managed care, will be essential in obtaining the required information for audits and claims processing. The position is hybrid, allowing for a combination of in-office and remote work. You will need to have a private home office setup with high-speed internet to facilitate your work from home. The work hours are from 8:00 am to 5:00 pm, Monday through Friday, providing a structured schedule that supports work-life balance. As a Stop Loss Accounting Analyst, you will play a vital role in ensuring that our members' stop-loss positions are accurately tracked and updated, contributing to the overall success of our claims management process.

Responsibilities
• Prepare and file 50% and 100% stop loss claim packets.
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• Run queries, compile eligibility data, and submit claim packets.
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• Audit stop loss positions by running queries and comparing to accumulated claims in the billing system.
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• Research variances, document discrepancies, and make appropriate adjustments.
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• Respond to audit letters and work with other areas to obtain requested information.
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• Track claims packet filing and MGU responses.
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• Log all submissions, audit letters receipts, and responses in the tracking database/log.
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• Provide manual monitoring of special stop loss scenarios including carved out pharmacy.
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• Ensure the member's stop loss positions are properly tracked and updated.
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• Perform complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions.
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• Create custom reports and spreadsheets based on customer inquiries.

Requirements
• Bachelor's degree in a job-related field or four years of job-related work experience or Associate's degree with two years of job-related work experience.
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• Three years of experience in accounting, auditing, billing, claims, membership, or finance.
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• Ability to compile information, perform research, and analyze data.
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• Strong customer service and organizational skills.
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• Excellent verbal and written communication skills.
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• Ability to take initiative and meet deadlines.
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• Attention to detail.
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• Intermediate Microsoft Office skills, including Access.

Nice-to-haves
• Experience within self-funded insurance programs, stop-loss, and/or accounting experience.
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• Experience with AMMS or Quicklink claims processing system.

Benefits
• 401(k) retirement savings plan with company match
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• Health insurance
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• Vision insurance
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• Life insurance
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• Paid annual leave
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• Nine paid holidays
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• On-site cafeterias and fitness centers in major locations
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• Wellness programs
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• Tuition assistance
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• Service recognition

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