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 onsite, full time (40 hours/week) Monday-Friday 8am-5pm in Columbia, SC.
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 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.
What We Prefer:
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
Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program 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 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…