Benefit Files Analyst I
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’s Degree OR 2 years of job-related analytical experience.
- 2 years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming.
- Strong analytical, interpersonal, communication (verbal and written), organizational, problem-solving, and decision-making skills.
- The ability to work independently and under pressure with tight deadlines.
- Excellent customer service skills.
- The ability to demonstrate logical abstract thinking and assimilating/adhering to project goals and deadlines.
- Knowledge of Microsoft Office applications to include Excel, Access and Outlook.
- Working knowledge of relevant operating systems.
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.
- Proficiency with DB2 / SQL and basic EZTrieve Plus and Visual Basic.
Responsibilities
- Work closely with analysts and team members to understand benefit plan designs and business requirements.
- Interpret, analyze and document quality solutions to meet plan design specifications.
- Based on approved design solutions, program and / or perform quality control audits of specific benefit data structures, RULEs, reports, and / or testing scenarios utilizing enterprise server (Benefit Files, RULEs, AMMS, claims, etc.).
- Coordinate 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.
- Meet quality, timeliness, and productivity standards.
- Develop process solutions to claims adjudication and eligibility in response to inquiries from other areas.
- Make recommendations toward the development of new solutions or reuse of existing solutions.
- Request queries and reports from internal / external sources for claim processing, Benefit Files or RULEs programming, and/or quality control audits.
- Develop and/or review quality control results in a timely manner.
- Perform any necessary debugging.
- Respond promptly to quality results allowing for the appropriate updates, data analysis and / or information to be provided to all the impacted areas.
Benefits
- 401(k) retirement savings plan with company match.
- Subsidized health plans and free vision coverage.
- Life insurance.
- Paid annual leave – the longer you work here, the more you earn.
- Nine paid holidays.
- On-site cafeterias and fitness centers in major locations.
- Wellness programs and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Incentive Plan.
- Merit Plan.
- Continuing education funds for additional certifications and certification renewal.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
