Benefit Files Analyst I

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

Under general supervision, the Benefit Files Analyst I interprets, reviews, and analyzes benefit plan designs and creates scope, design, and specification documents for programming benefits. The role programs and/or audits benefits in the Benefit Files and/or RULEs databases to support timely and accurate claims and eligibility processing. It also helps develop process solutions for business problems affecting the lines of business supported by the department and analyzes upcoming system changes for their impact on claims adjudication, rules, and customer-maintained tables. This is a full-time, onsite position in Columbia, South Carolina, scheduled Monday through Friday, 8:00 a.m. to 5:00 p.m. (40 hours per week).

Requirements

Associate's degree, or an equivalency of two years of job-related work experience.
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 demonstrate logical, abstract thinking and to assimilate and adhere to project goals and deadlines.

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 and 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 perform quality-control audits of benefit data structures, RULEs, reports, and testing scenarios using enterprise systems, including Benefit Files, RULEs, AMMS, and claims systems.
Coordinate with information systems and lines-of-business customers on developing, setting up, and testing new and existing benefit data structures and RULEs while meeting quality, timeliness, and productivity standards.
Develop process solutions for claims adjudication and eligibility in response to inquiries from other areas.
Recommend development of 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 in a timely manner.
Perform necessary debugging.
Respond promptly to quality results and provide appropriate updates, data analysis, and information to impacted areas.