Stop Loss Registered Nurse

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Assess and oversee catastrophic health incidents for underwriting and claims processes.

• Ensure that insured members receive optimal medical care while maintaining cost efficiency.

• Provide cost estimates for underwriters regarding new and renewal stop loss business.

• Collaborate with underwriters on catastrophic health incidents.

• Oversee case management related to managed care between the TPA and the organization.

• Analyze potential claim notifications and excessive claims to establish reserve settings.

• Review possible claim notifications from TPAs.

• Investigate cost containment strategies and intervene with the TPA as needed.

• Work Monday to Friday, 40 hours per week, on an 8-hour shift between 6:00am and 6:00pm.

⛳️ Requirements

• An associate degree in a relevant field.

• Graduate from an accredited nursing program.

• 10 years of professional experience: 5 years in a clinical setting plus 5 years in medical management.

• Current RN licensure in the state of employment.

• Proficient in word processing software.

• Exceptional verbal and written communication skills.

• Ability to work autonomously, effectively prioritize tasks, and make informed decisions.

• Familiarity with managed care and various health care delivery systems.

• Knowledge of catastrophic claims costs, medical vendors, and case management.

• Proven customer service, communication, and organizational abilities.

• Strong analytical and critical thinking skills.

• Capable of handling confidential or sensitive information with care.

• Proficient in Microsoft Office.

• Experience working with a stop loss carrier and assisting underwriting and claims with medical cost initiatives.

• Extensive case management and managed care experience.

• Experience with Medicare and/or Medicaid.

• Familiarity with HMO reinsurance.

• Prior experience in solutions-based consulting to effectively collaborate with a diverse range of clients.

• Ability to review and analyze large volumes of claims data and clinical information.

🏝️ Benefits

• Subsidized health plans, along with dental and vision coverage.

• 401k retirement savings plan with company matching contributions.

• Life insurance coverage.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers available at major locations.

• Educational assistance programs.

• Service recognition awards.

• National discounts for movies, theaters, zoos, theme parks, and more.

• Approximately 25% travel required to visit clients or attend team meetings and conferences; travel expenses will be reimbursed.

• Eligibility for benefits starts on the first of the month following 28 days of employment.