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Benefit Files Analyst I

4 months ago

Columbia, South Carolina, United States BlueCross BlueShield of South Carolina Full time

Summary

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

Description

Job Purpose:

Under general supervision, responsible for interpreting, reviewing, and analyzing benefit plan designs. Responsible for creating scope, design and specification documents for programming of benefits from benefit plan designs. Responsible for programming and / or auditing benefits within the Benefit Files and / or RULEs databases to ensure timely and accurate claims and eligibility processing. Assists in the development of process solutions to business problems impacting applicable lines of business the department supports. Analyzes upcoming systems changes to determine the impact to claims adjudication as it relates to rules and customer-maintained tables.

Logistics:

This position is full-time (40 hours/week, 8 hours/day) Monday - Friday in a typical office environment and is located onsite at 4101 Percival Road in Columbia, SC. There is the possibility of remote work/flexible work arrangement once training is complete and performance standards are being met.

What You'll Do:

  • Work closely with analysts and team members to understand benefit plan designs and business requirements. Interpret, analyze and document quality solutions to meet plan design specifications.
  • Based on approved design solutions, program and / or perform quality control audits of specific benefit data structures, RULEs, reports, and / or testing scenarios utilizing enterprise server (Benefit Files, RULEs, AMMS, claims, etc.).
  • Coordinate with information systems and all lines of business customers on the development, set up and testing of new and existing benefit data structures and RULEs. Meet quality, timeliness, and productivity standards.
  • Develop process solutions to claims adjudication and eligibility in response to inquiries from other areas. Make recommendations toward the development of new solutions or reuse of existing solutions. Request queries and reports from internal / external sources for claim processing, Benefit Files or RULEs programming, and/or quality control audits.
  • Develop and/or review quality control results in a timely manner. Perform any necessary debugging. Respond promptly to quality results allowing for the appropriate updates, data analysis and/or information to be provided to all the impacted areas.

To Qualify for This Position, You'll Need:

  • An Associate's Degree OR 2 years of job-related analytical experience.
  • 2 years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming.
  • Strong analytical, interpersonal, communication (verbal and written), organizational, problem-solving, and decision-making skills.
  • The ability to work independently and under pressure with tight deadlines.
  • Excellent customer service skills.
  • The ability to demonstrate logical abstract thinking and assimilating/adhering to project goals and deadlines.
  • Knowledge of Microsoft Office applications.
  • Working knowledge of relevant operating systems.

We Prefer You to Have:

  • A Bachelor's Degree in Computer Science, Mathematics, Management of Information Systems (MIS) or Business Administration.
  • 4 years of related work experience.
  • Computer programming and computer systems support skills.
  • Proficiency with DB2 / SQL and basic EZTrieve Plus and Visual Basic.

What Blue Can Do for You:

Our comprehensive benefits package includes:

  • 401(k) retirement savings plan with company match.
  • Subsidized 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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail or call , ext with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.