Benefit Files Analyst I

Blue Cross Blue Shield; Columbia (SC); On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

PTO

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina in Columbia, SC is seeking an experienced analyst to interpret benefit plan designs, develop scope and specifications for programming, and audit benefits within Benefit Files and RULEs databases. You will collaborate with analysts to translate requirements, develop and test solutions, and ensure timely processing of claims and eligibility.

You will work closely with cross-functional teams to meet quality, timeliness, and productivity standards, performing

Qualifications

• Required Education: Associate's Degree or 2 years related work experience.
• 2 years of experience in systems analysis, statistical analysis, claims processing or information systems.
• Strong analytical, interpersonal, communication, organizational, problem-solving and decision-making skills.

Responsibilities

• Interpret, analyze, and document quality solutions to meet plan design specifications.
• Program and/or perform quality control audits of benefit data structures, RULEs, reports, and testing scenarios.
• Coordinate with IS and business customers on development, setup, and testing of benefit data structures and RULEs.

Skills

Analytical skills

Communication

Problem solving

Team collaboration

Independence under pressure

Education

Associate's Degree or 2 years related experience

Tools

DB2/SQL

EZTrieve Plus

Visual Basic

Job description

SummaryUnder 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.DescriptionLocationThis 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 requirementsInterprets, analyzes, and documents quality solutions to meet plan design specificationsBased 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 standardsDevelops process solutions to claims adjudication and eligibility in response to inquiries from other areasMakes recommendations toward the development of new solutions or reuse of existing solutionsRequests queries and reports from internal / external sources for claim processing, Benefit Files or RULEs programming, and/or quality control auditsDevelops and/or reviews quality control results in a timely mannerPerforms any necessary debuggingResponds promptly to quality results allowing for the appropriate updates, data analysis and / or information to be provided to all the impacted areasTo Qualify for This Position, You Will Need:Required Education: Associate'sDegree Equivalency: 2 years job related work experienceRequired Work Experience: 2 years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programmingRequired 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 AdministrationPreferred Work Experience: 4 years-of related work experiencePreferred 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 BasicOur 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 employmentSubsidized health plans, dental and vision coverage401k retirement savings plan with company matchLife InsurancePaid Time Off (PTO)On-site cafeterias and fitness centers in major locationsEducation AssistanceService RecognitionNational discounts to movies, theaters, zoos, theme parks and moreWhat 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 StatementBlueCross 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 [e-mail] 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 .