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.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
This position is not eligible for sponsorship now or in the future.
Description
Logistics: BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina
Location: This position is full-time (40-hours/week) Monday-Friday in typical office environment. You will work an 8-hour shift, 7:30AM – 4:30PM. This role is located onsite at 4101 Percival Road, Columbia, SC 29229.
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 the Following:
- Required Education: Associate Degree
- 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 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.
- Required Software and Tools: Working knowledge of relevant operating systems. Microsoft Office.
To Qualify for This Position, You’ll Need the Following:
- Preferred Education: Bachelor's Degree-in Computer Science, Mathematics, Management of Information Systems (MIS) or Business Administration.
- Preferred Work Experience: 4 years-of related work experience.
- Preferred Skills and Abilities: 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.Work Environment: Typical office environment.
Our Comprehensive Benefits Package Includes The Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more
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.
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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 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.
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