Benefit Files Analyst I

BlueCross BlueShield of South Carolina•Columbia, SC

6d•Onsite

About The Position

Under general supervision, the Benefit Files Analyst I interprets, reviews, and analyzes benefit plan designs; creates scope, design, and specification documents for benefit programming; and programs and/or audits benefits in Benefit Files and RULEs databases to support timely, accurate claims and eligibility processing. The role also helps develop process solutions for business problems affecting supported lines of business and analyzes systems changes for their impact on claims adjudication, rules, and customer-maintained tables. The position works closely with analysts and team members to understand benefit plan designs and requirements, document solutions, and program or quality-audit benefit data structures, RULEs, reports, and testing scenarios using enterprise systems. It coordinates with Information Systems and business customers on developing, setting up, and testing benefit data structures and RULEs. The analyst develops solutions to claims-adjudication and eligibility issues, reviews quality-control results, performs debugging, and provides timely updates and analysis to affected teams. This is a full-time, onsite position in a typical office environment at 4101 Percival Road, Columbia, South Carolina. The schedule is Monday through Friday, 40 hours per week, on an eight-hour shift from 7:30 a.m. to 4:30 p.m. The position is not eligible for sponsorship now or in the future.

Requirements

Associate degree, or two years of job-related work experience as a degree equivalency.
Two years of experience in systems analysis, statistical analysis, claims processing, or information systems/computer programming.
Strong analytical, interpersonal, verbal and written communication, organizational, problem-solving, and decision-making skills.
Ability to work independently and under pressure with tight deadlines.
Excellent customer service skills.
Ability to think logically and abstractly and to assimilate and adhere to project goals and deadlines.
Working knowledge of relevant operating systems.
Knowledge of Microsoft Office.

Nice To Haves

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

Responsibilities

Work with analysts and team members to understand benefit plan designs and business requirements.
Interpret, analyze, and document solutions that meet plan design specifications.
Program and/or quality-audit benefit data structures, RULEs, reports, and testing scenarios using enterprise systems.
Coordinate with Information Systems and business customers on the development, setup, and testing of new and existing benefit data structures and RULEs.
Meet quality, timeliness, and productivity standards.
Develop process solutions for claims-adjudication and eligibility issues raised by other areas.
Recommend new solutions or reuse of existing solutions.
Request queries and reports from internal or external sources for claims processing, Benefit Files or RULEs programming, and quality-control audits.
Develop and/or review quality-control results promptly and perform necessary debugging.
Respond to quality results with appropriate updates, data analysis, and information for impacted areas.
Analyze upcoming system changes for their impact on claims adjudication, rules, and customer-maintained tables.