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Work From Home Stop Loss Rn Jobs in Lexington, SC

The Semler Agency

Work From Home Sales

Columbia, SC · On-site +1

This role is designed for individuals looking to learn a new skill and work from home with support. Responsibilities: * Connect with individuals requesting information * Provide guidance on coverage ...

HMG Careers

Work From Home Sales Specialist

Columbia, SC · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Columbia, SC · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Olympia, SC · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Columbia, SC · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Chapin, SC · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Red Bank, SC · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

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All JobsStop Loss Rn JobsWork From Home Stop Loss Rn JobsWork From Home Stop Loss Rn Jobs in Lexington, SC

Work From Home Stop Loss Rn information

See Lexington, SC salary details

$58.2K

$97.9K

$176.3K

How much do work from home stop loss rn jobs pay per year?

As of Aug 25, 2026, the average yearly pay for work from home stop loss rn in Lexington, SC is $97,899.00, according to ZipRecruiter salary data. Most workers in this role earn between $84,300.00 and $108,300.00 per year, depending on experience, location, and employer.

What is a Work From Home Stop Loss RN?

A Work From Home Stop Loss RN is a registered nurse who works remotely, typically for insurance companies or third-party administrators, to review medical claims associated with stop loss insurance policies. Their main responsibility is to assess the medical necessity and appropriateness of claims that exceed certain thresholds, helping employers and insurers manage high-cost healthcare claims. These nurses use their clinical expertise to analyze medical records, communicate with providers, and ensure that claims are processed accurately and efficiently. Working from home allows them to perform these tasks virtually, often using secure digital platforms.

What are the key skills and qualifications needed to thrive as a Work From Home Stop Loss RN?

To thrive as a Work From Home Stop Loss RN, you need a current RN license, strong clinical assessment skills, and experience in utilization review or case management. Familiarity with health insurance systems, stop loss claims processes, and electronic medical record (EMR) platforms is typically required. Excellent attention to detail, critical thinking, and effective written communication are crucial soft skills for remote collaboration and accurate documentation. These abilities ensure accurate claim evaluations, regulatory compliance, and efficient coordination with insurers and healthcare providers.

What are some common challenges faced by Work From Home Stop Loss RNs, and how can they be addressed?

Work From Home Stop Loss RNs often face challenges related to remote communication, maintaining up-to-date clinical knowledge, and managing a high volume of case reviews. Since collaboration is primarily virtual, it's important to develop strong written and verbal communication skills to effectively coordinate with physicians, case managers, and insurance teams. Staying current with clinical guidelines and leveraging digital tools for documentation and workflow management can help streamline responsibilities and ensure accurate decision-making. Building a structured daily routine and proactively seeking support from team leads or mentors can also help address feelings of isolation and ensure ongoing professional growth.

What is the difference between Work From Home Stop Loss Rn vs Work From Home Case Manager?

AspectWork From Home Stop Loss RnWork From Home Case Manager
CredentialsRN license, certifications in insurance or risk managementRN license, case management certification
Work EnvironmentHome-based, insurance and healthcare settingsHome-based, healthcare and insurance industries
Industry UsageInsurance companies, healthcare providersInsurance companies, healthcare organizations
Job FocusManaging stop loss insurance claims and riskCoordinating patient care and insurance processes

While both roles require RN licensure and healthcare knowledge, the Work From Home Stop Loss Rn focuses on managing insurance claims related to stop loss coverage, emphasizing risk assessment. In contrast, the Work From Home Case Manager concentrates on coordinating patient care and insurance processes. Both roles are home-based and serve the healthcare and insurance industries, but their primary responsibilities differ significantly.

What are popular job titles related to Work From Home Stop Loss Rn jobs in Lexington, SC?

For Work From Home Stop Loss Rn jobs in Lexington, SC, the most frequently searched job titles are:

What job categories do people searching Work From Home Stop Loss Rn jobs in Lexington, SC look for?

The top searched job categories for Work From Home Stop Loss Rn jobs in Lexington, SC are:

What cities near Lexington, SC are hiring for Work From Home Stop Loss Rn jobs?

Cities near Lexington, SC with the most Work From Home Stop Loss Rn job openings:

Work From Home Stop Loss Rn jobs near you
Infographic showing various Work From Home Stop Loss Rn job openings in Lexington, SC as of August 2026, with employment types broken down into 67% Full Time, 23% Part Time, and 10% Contract. Highlights an 100% Remote job distribution, with an average salary of $97,899 per year, or $47.1 per hour.

Senior Stop Loss Claims Auditor

BlueCross BlueShield of South Carolina

Columbia, SC • On-site, Remote

$72K - $94K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 8 days ago

BlueCross BlueShield of South Carolina rating

7.5

Company rating: 7.5 out of 10

Based on 70 frontline employees who took The Breakroom Quiz

211th of 311 rated insurance

Job description

Summary
Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service.
Description
Position Purpose
Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service.
Companion Life - one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST and will be fully remote.
What You'll Do:
  • Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.
  • Initiate claims investigations and vendor referrals. Interpret plan language, and identify experimental services and subrogation opportunities. 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 to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history.
  • Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors, and training of claims auditors.

To Qualify for This Position, You'll Need the Following:
  • Required Education: Associate's
  • Degree Equivalency: 2 years of job-related work experience
  • Required Work Experience: 6 years of managed care or reinsurance claims experience.

We Prefer That You Have the Following:
  • Preferred Skills and Abilities:
  • Analyzes laws, regulations and contract language.
  • Evaluates issues and develops recommendations.
  • Handles confidential and sensitive information.
  • Investigates assigned claims.
  • Proposes claims adjustments and refunds.
  • Works claims caseloads.
  • Aggregate claims experience.

Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
  • 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

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 the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
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.
Pay Range Information:
Range Minimum
$49,447.00
Range Midpoint
$72,092.00
Range Maximum
$94,737.00
Pay Transparency Statement:
Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.

What BlueCross BlueShield of South Carolina employees say

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Benefits

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Get the full story on Breakroom

BlueCross BlueShield of South Carolina logo

About BlueCross BlueShield of South Carolina

Sourced by ZipRecruiter

BlueCross BlueShield of South Carolina, headquartered in Columbia, SC, USA, is a major stakeholder in the country's healthcare sector. The company holds the distinction of being one of the largest health insurers in South Carolina. As an independent licensee of the BlueCross BlueShield Association, it offers an extensive range of health insurance products and services, focusing not just on medical coverage, but also on dental, vision, and other supplementary health options. The company was founded in 1946 and has since established itself as a trusted leader in the health sector, committed to affordability, accessibility, and customer service. Their mission is to ensure that all South Carolinians have access to high-quality healthcare and exemplify the core values of accountability, transparency, and commitment to customer satisfaction.

Industry

Insurance services

Company size

10,000+ Employees

Headquarters location

Columbia, SC, US

Year founded

1946

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