Benefit Files Analyst I

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

Employee discounts

Job summary

BlueCross BlueShield of South Carolina, located in Columbia, SC, seeks a benefits systems analyst to interpret and analyze benefit plan designs and translate them into executable specifications. The role involves programming and auditing benefit data structures, RULEs, and testing scenarios within enterprise systems.

The candidate will collaborate with IS and business teams to implement new and existing data structures, ensure quality and timely processing, and support claims adjudication and

Qualifications

• Bachelor degrees in CS or MIS/Business Admin required or two years of analytical experience.
• Two years of system analysis, statistics, claims processing, or information systems experience preferred.

Responsibilities

• Interpret, analyze, and document quality solutions matching plan design specifications.
• Program and/or audit benefit data structures, RULEs, and related testing scenarios.
• Coordinate with IS and business customers on setup and testing of benefit data structures and RULEs.
• Develop/process solutions to support claims adjudication and eligibility.

Skills

Analytical skills

Interpersonal skills

Communication

Organizational skills

Problem solving

Decision making

Customer service

Education

Bachelor's Degree in Computer Science

Bachelor's Degree in MIS/Business Administration

Associate Degree

2+ years analytical experience

Tools

Microsoft Office

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.

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but we've been part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Location

This position is full-time (40-hours/week) Monday-Friday in typical office environment. You will work an 8-hour shift, 7:30AM – 4:30PM. This role is located onsite at 4101 Percival Road, Columbia, SC 29229.

What You’ll 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

Required Education: Associate Degree or 2 years of job related analytical experience. Required Education: Bachelor's Degree in Computer Science, Mathematics, management of Information Systems (MIS) or Business Administration. Required Work Experience: Two years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming. Preferred Work Experience: Four years related work experience.

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.

Software and Other Tools

Working knowledge of relevant operating systems Microsoft office.

Our Comprehensive Benefits Package Includes

• 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.

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 [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beauport and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.