Benefit Files Analyst I

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

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.

Requirements

Associate degree.
2-years job related work experience
2-years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming.
Working knowledge of relevant operating systems.
Microsoft Office.
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.

Nice To Haves

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

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.