Benefit Files Analyst I

Summary

Position Purpose

As a Benefit Files Analyst I, under general supervision, you will interpret, review, and analyze benefit plan designs and will be responsible for creating scope, design and specification documents for programming of benefits from benefit plan designs. You will also be responsible for programming and/or auditing benefits within the Benefit Files and / or RULEs databases to ensure timely and accurate claims and eligibility processing.

Utilizing your experience, you will assist in the development of process solutions to business problems impacting applicable lines of business the department supports and analyze upcoming systems changes to determine the impact to claims adjudication as it relates to rules and customer-maintained tables.

Description

What You'll Do:

• Request queries and reports from internal/external sources for claim processing, Benefit Files or RULEs programming, and/or quality control audits.
• 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.).
• 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.
• 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.
• 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.
• 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.

To Qualify For This Position, You'll Need

• Associate Degree OR 2 years of job-related analytical experience.
• Strong analytical, interpersonal, communication (verbal and written), organizational, problem-solving and decision-making skills.
• Excellent customer service skills.
• 2 years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming.
• Ability to work independently and under pressure with tight deadlines.
• Demonstrates logical abstract thinking and assimilating/adhering to project goals and deadlines.
• Working knowledge of relevant operating systems. Microsoft Office.

We Prefer You Have

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

Work Environment

• Typical office environment.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.