Benefits Data & Rules 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

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.