Serves as lead analyst in interpreting, analyzing, reviewing, documenting, programming and/or auditing complex accounts and in communications with clients to ensure business priorities are met. Identifies systems problems and develops solutions. Oversees quality control activities for programming of benefits and eligibility, RULEs, modifications and work completed by other internal customers.
This is a possible work from home subsequent training position.
Required Work Experience:
Four years of experience working in systems analysis, statistical analysis, claims processing or information systems.
Two years systems analysis experience (may be concurrent with 4 years above).
Two years DB2 experience (creating / modifying queries).
Two years Eztrieve Plus (may be concurrent with DB2 experience).
Prior planned building in RIMS/QIK Links System experience.
Required Skills and Abilities:
Demonstrated ability to manage relationships with customers in a consulting capacity and to apply project planning, organizational and management concepts and use them in a lead role.
Able to document complex problems and assist in resolution.
Mentor others in the concepts of supporting corporate decision-making and system capabilities through use of various system and analysis tools and techniques.
Ability to review complex benefit structures and provide feedback on how they can be approximated in the system, what variances would arise based on plan design, and claims or eligibility processing limitations as they currently exist.
Demonstrated ability to create and modify queries in DB2 and/or EZTrieve Plus.
Understands and can incorporate the latest procedural developments in health care, as well as current trends in the marketplace concerning benefit and/or RULEs administration.
Ability to interpret group contractual provisions and understand the ways they can be expressed within existing benefits file and/or RULEs structures while making independent decisions.
Ability to express complex technical concepts in terms that are understandable to the business units. In-depth knowledge of relationship between benefit master files, benefit, eligibility, and/or RULEs database design concepts, system procedures and processing for claims adjudication.
Understanding of quality control/auditing concepts.
Comprehensive knowledge of claims processing structure and company systems including procedure and diagnosis coding and their relationships to type and place of service as well as supporting system files and procedure master files.
Business math proficiency.
Strong interpersonal analytical, problem-solving and decision making skills.
Excellent communication (verbal and written) and organizational skills.
Demonstrates logic abstract thinking and assimilating/adhering to project goals.
Excellent customer service skills.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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 firstname.lastname@example.org or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
Bluecross Blueshield Of South Carolina