Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Description
 

Job Purpose:

Reviews and researches D9BLK report for medical deferrals.  Responsible for reconciliation of mismatches between PBM/BCBSSC accumulators applied to deductible and/or OOP as indicated on the AMC6 workload and/or Summary History. Researches and works Out of Balances (OOB) for PBMs as reported.  Reviews medical and pharmacy claims and customer service inquiries related to accumulators and resolves OOB for members.

Logistics:

This position is full-time (40 hours/week, 8 hours/day) Monday – Friday and is located onsite at 4101 Percival Road in Columbia, SC.  A flexible work arrangement is possible once training is complete and performance standards are being met.

What You'll Do:

• Prepare and review test data and test matrices for system changes. Develop test matrices to accurately reflect changes and details expected outcome. Execute test cases and evaluate test results for errors.
• Report problems through appropriate channels and suggests corrections for a successful implementation. Utilize internal and external software necessary to support testing and development of skills.
• Research and document system problems and assists in their resolution. Review and complete various daily reports to ensure system is performing as expected. Prepare written reports and analysis, including recommendations pertaining to system functionality. Utilize internal and external applications for technical research of system issues.
• Function as a liaison between the production operations areas, other area testers and Information Systems to facilitate communications. In addition, assist customers and testers with issues that arise both in production and during testing.

To Qualify for This Position, You'll Need:

• A High School Diploma or equivalent.
• 2 years of experience working in related processing support systems.
• Basic business math skills.
• Strong verbal and written communication skills.
• Related systems support knowledge.
• Strong research and analytical skills.
• Attention to detail.
• Microsoft Office.

We Prefer You to Have:

• A Bachelor’s Degree in Business, Healthcare, Information Technology or other job-related field.
• Experience with DB2, TI TOOL, Access Database, Microsoft Excel and Quality Center.
• Experience with AMMS/medical/pharmacy claims.

What Blue Can Do for You:

Our comprehensive benefits package includes:

• 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