Files Analyst

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 Blue Cross Blue Shield 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:
Blue Cross Blue Shield of South Carolina - About Us| Blue Cross Blue Shield 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 or 2 years of job related analytical experience.

To Qualify for This Position, You’ll Need the Following:

Required

Education:

Bachelor's Degree in Computer Science, Mathematics, management of Information Systems (MIS) or Business Administration.

Required

Work Experience:

Two years of experience working in systems analysis, statistical analysis, claims processing or information systems/computer programming.

Preferred

Work Experience:

Four years related work experience.

Skills and Abilities:

Strong analytical, interpersonal, communication (verbal and written), organizational, problem solving and…