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

This position is full time (40 hours/week) Monday-Friday 8am-5pm and will be onsite at our Percival Rd location in Columbia, SC.

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

What You Will 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 Will 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

• 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

What We Prefer:

• 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

What We Can Do for You:

• 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.

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 a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

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.

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

Some states have required notifications. Here's more information.