Benefit Files Analyst I

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a benefits analyst to interpret, review, and analyze benefit plan designs, and to develop scope and specifications for programming changes.

In this onsite, full-time role in Columbia, SC, you will collaborate with analysts to document requirements, perform quality control audits of benefit data structures and RULEs, and support implementation of new solutions for claims adjudication and eligibility.

Qualifications

• Required Education: Associate's
• Degree Equivalency: 2 years job related work experience
• Required Work Experience: 2 years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming

Responsibilities

• Works closely with analysts and team members to understand benefit plan designs and business requirements
• Interprets, analyzes, and documents quality solutions to meet plan design specifications
• Based on approved design solutions, programs and / or performs quality control audits of specific benefit data structures, RULEs, reports, and / or testing scenarios utilizing enterprise server (Benefit Files, RULEs, AMMS, claims, etc.)
• Coordinates 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. Meets quality, timeliness, and productivity standards
• Develops process solutions to claims adjudication and eligibility in response to inquiries from other areas
• Makes recommendations toward the development of new solutions or reuse of existing solutions
• Requests queries and reports from internal / external sources for claim processing, Benefit Files or RULEs programming, and / or quality control audits
• Develops and / or reviews quality control results in a timely manner
• Performs any necessary debugging
• Responds promptly to quality results allowing for the appropriate updates, data analysis and / or information to be provided to all the impacted areas

Skills

Analytical

Communication

Interpersonal

Organizational

Problem solving

Customer service

Education

Associate's degree

Bachelor's degree preferred

Tools

DB2

SQL

EZTrieve Plus

Visual Basic

Job description

Summary

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.

Description

Location

This position is onsite, full time (40 hours/week) Monday-Friday 8am-5pm in Columbia, SC.

What You Will Do:

• Works closely with analysts and team members to understand benefit plan designs and business requirements
• Interprets, analyzes, and documents quality solutions to meet plan design specifications
• Based on approved design solutions, programs and / or performs quality control audits of specific benefit data structures, RULEs, reports, and / or testing scenarios utilizing enterprise server (Benefit Files, RULEs, AMMS, claims, etc.)
• Coordinates 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. Meets quality, timeliness, and productivity standards
• Develops process solutions to claims adjudication and eligibility in response to inquiries from other areas
• Makes recommendations toward the development of new solutions or reuse of existing solutions
• Requests queries and reports from internal / external sources for claim processing, Benefit Files or RULEs programming, and / or quality control audits
• Develops and / or reviews quality control results in a timely manner
• Performs any necessary debugging
• Responds 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 Will Need:

• Required Education: Associate's
• Degree Equivalency: 2 years job related work experience
• Required Work Experience: 2 years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming
• Required Skills and abilities: Strong analytical, interpersonal, communication (verbal and written), organizational, problem-solving and decision-making skills. Ability to work independently and under pressure with tight deadlines. Excellent customer service skills. Demonstrates logical abstract thinking and assimilating / adhering to project goals and deadlines.

What We Prefer:

• Preferred Education: Bachelor's Degree-in Computer Science, Mathematics, Management of Information Systems (MIS) or Business Administration
• Preferred Work Experience: 4 years-of related work experience
• Preferred Skills and Abilities: Computer programming and computer systems support skills.
• Preferred Software and Other Tools: Computer programming and computer systems support skills. Proficiency with DB2 / SQL and basic EZTrieve Plus and Visual Basic

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program 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 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.

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.

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