Summary
 

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.

Description
 

Location:

Work Environment: Typical office environment.

What You'll Do:

• 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.

To Qualify for This Position, You'll Need:

• Required Education: Associate's
• Degree Equivalency: 2 years job related work experience
• Required Work Experience: 2 years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming.
• Required Software and Tools: Working knowledge of relevant operating systems. Microsoft Office.

Required Skills and Abilities:

• 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.

We Prefer That You Have The Following:

• 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.

Preferred Software and Other Tools: Computer programming and computer systems support skills. Proficiency with DB2 / SQL and basic EZTrieve Plus and Visual Basic.

Our comprehensive benefits package includes the following:

• 401(k) retirement savings plan with company match
• Fantastic 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 significant locations
• Wellness programs and a healthy lifestyle premium discount
• Tuition assistance
• Service Recognition

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

 

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

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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. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.