Senior Stop Loss Claims Auditor

BlueCross BlueShield of South Carolina

Senior Stop Loss Claims Auditor at BlueCross BlueShield auditing and authorizing specific medical claims. Providing client support while mitigating stop loss claims.

Posted 7/17/2026full-timeRemote • South Carolina • 🇺🇸 United StatesSenior💰 $49,447 - $94,737 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing and authorizing medical stop loss claims, with a strong focus on customer service and effective communication with carriers and vendors. Proficient in analyzing claims, identifying cost mitigation opportunities, and maintaining accurate claims system reports.

Highest-signal resume keywords

Medical Stop Loss Claims AuditingClaims Analysis and AdjudicationCustomer Service ExcellenceManaged Care Claims ExperienceClaims Investigation and Resolution

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Reimbursement AuthorizationCost Mitigation AnalysisClaims System ReportingPlan Language InterpretationClaims Form Development

Soft Skills

Effective CommunicationProblem Solving

Industry Keywords

Managed CareReinsuranceClaims AuditingVendor ReferralsPended Claims Resolution

About the role

Key responsibilities & impact

Audit and authorize reimbursement of specific medical stop loss claims
Effectively mitigate client medical stop loss claims and provide excellent customer service
Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier
Recognize cost mitigation opportunities
Authorize and release stop loss claims reimbursement checks
Initiate claims investigations and vendor referrals
Interpret plan language and identify experimental services
Identify need for follow-up on pended claims and resolution
Communicate effectively with carriers, vendors, and management
Provide full claims service to both phone and written inquiries
Generate and maintain claims system reports
Develop new and review old stop loss claim forms
Assist with internal auditing of claims auditors and training of claims auditors

Requirements

What you’ll need

Associate's Degree or 2 years of job-related work experience
6 years of managed care or reinsurance claims experience

Benefits

Comp & perks

Subsidized health plans
Dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more