Benefit Files Analyst I

BlueCross BlueShield of South Carolina•Columbia, SC

5h•Onsite

About The Position

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

Requirements

Associate's degree, or an equivalent 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.
Logical, abstract thinking and the ability to assimilate and adhere to project goals and deadlines.

Nice To Haves

Bachelor's degree in computer science, mathematics, management 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 quality-control audit 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.
Meet quality, timeliness, and productivity standards.
Develop process solutions for claims adjudication and eligibility issues raised by 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.
Analyze upcoming systems changes for their impact on claims adjudication, rules, and customer-maintained tables.