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Position Description

Arkansas Blue Cross and Blue Shield - EXEMPT POSITION DESCRIPTION

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Position:  Benefit Analyst
Reports To: 
Division:  Blue Adv Confg & Analysis (2500)
Company:  ABCBS
Location:  Label
Job Code:  F31415
Min Salary:   51000
Date Posted:  9/30/2009

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Position Specific Requirements: No position specific requirements


Job Summary

The Benefit Analyst is responsible for identification of benefits for new groups and benefit changes for existing groups, accurate and timely coding of such additions and changes, and preparing the necessary related documentation for internal and external customers in order to ensure the highest possible level of automation and quality related to benefit administration.

This position is also responsible for the testing and installation of releases by DSTHS (DST Health Solutions) as well as supporting the Enterprise wide integration activities.   This position is also accountable for special projects and workflow as directed.

Nature & Scope
Environment

This position reports to the Configuration Supervisor. The incumbent works closely with all members of the AMISYS configuration & analysis team; internal and external users and customers; and the BlueAdvantage Operations staff to ensure problems and questions are researched and resolved in a timely manner.

Workflow

This position will receive work assignments from the Configuration Supervisor and the Manager of the AMISYS configuration & analysis team.  This position receives system problems and requests for assistance from various system users, both internal and external, throughout the enterprise including clients and vendors.  Problems and/or requests submitted must be researched and resolved in a timely and accurate manner.  There are specific aspects of projects that can be delegated to the Benefit Technician.  When delegated, this position is expected to provide guidance and direction to the Technician.

Work assignments may also be self-imposed, as a result of analysis and identification of resolutions for submitted problems by internal and external users.

Guidance

This position reports directly to the Configuration Supervisor.  This position is guided by benefit policies and procedures, as well as, AMISYS subsystem procedures.

Challenge

The major challenges for this position include:

• To ensure that benefits for new groups and existing groups who implement benefit changes are properly identified and coded into AMISYS in the most efficient manner, thereby allowing for accurate claim adjudication with the least amount of examiner intervention possible.

• To ensure that descriptions of each benefit plan are developed and distributed in an accurate and timely fashion.

• To identify and implement coding mechanisms to maximize efficiency, quality and system automation. This includes the identification and recommendation of system modifications or alternatives to enhance efficiency, in addition to the testing of new system releases and fixes.

• To closely coordinate system configuration and benefit descriptions with the Plan Document Analyst in order to ensure consistency.

Interfaces

Principal contacts within the enterprise include operations staff, AMISYS configuration & analysis team, training and quality assurance staff, and regional office staff.

Principal contacts outside the enterprise include external clients, Amisys Synertech Inc., client consultants, and client vendors.

Authority

This position has the authority to make decisions regarding utilization of the most effective method of benefit coding resulting in quality adjudication of claims and customer service.  This includes resolving system problems reported by internal and external system users and providing guidance to the Benefit Technician.


Minimum Job Requirements

 

Level 1

 

1. High school diploma or equivalent.

2. Meet one or both of the following:

Bachelor's degree in business or healthcare management related field from an accredited college or university.

Health related non-clerical experience with an insurance, managed care or healthcare organization.

3. Analysis and/or research experience with a complex system technology.

4. Possess in-depth knowledge of the functions of AMISYS, managed care, insurance or third-party administrative services, or complex claims processing systems technology.

5. Prefer claims, eligibility, or other medical related experience with thorough knowledge of claims processing procedures; and experience with the AMISYS system or a claims processing equivalent.

6. Project Management experience preferred.

Level 2

 

  1.  Experience as Level 1 Analyst.
  2. Certification in 1 AMISYS subsystem; or demonstrated expertise in 1 AMISYS subsystem (as determined by the analyst's supervisor and manager), if certification is unavailable.
  3. No oral or written warning within the last 6 months.
  4. Project experience required:
    1. Serve as overall project lead on 1 medium project and as lead for a category of tasks on 2 large projects.  (Determination of project size is made by the division manager.)
  5. Create and update individual development plan (IDP) annually; actively pursue professional development goals included in IDP.
  6. Successful completion of 3 enterprise or LOB classes that are related to leadership or personal development; classes must be approved by Configuration Supervisor.
  7. Actively participate in BAU/HAU and support positive internal/external customer experience. 
  8. Demonstrated ability to utilize database query tools.

Level 3

  1. Experience as Level 2 Analyst.
  2. Project experience required:
    1. Serve as overall project lead on 2 large projects which include multiple AMISYS subsystems, functional areas, etc.; or
    2. Achieve Project Leader Certification through BAU, HAU or enterprise project management processes.
  3. No oral or written warning within the last 6 months.
  4. Create and update individual development plan (IDP) annually; actively pursue professional development goals included in IDP.
  5. Successful completion of 3 self-initiated self-development classes; classes must be approved by Configuration Supervisor.
  6. Test/project/workplan development experience.
  7. Serve as subject matter expert and/or facilitator for at least one educational class (i.e. BAU, HAU or strength training.)
  8. Demonstrated ability to develop and produce complex database queries.

Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
1. To identify, code, maintain and document configuration of claims adjudication formulas in the Benefit Subsystem.
2. Develops and implements test plans for installing “patch” tapes and major releases of the AMISYS software.
3. Develops benefit plan descriptions.
4. Determines impact on claims adjudication that would be created by the addition of new plans or modification of existing benefits.
5. Analyzes and resolves system problems reported by external and internal users.
6. Attends and/or facilitates new group implementation meetings to obtain detailed benefit information.
7. Ensures that the Configuration Supervisor is aware of all problems and the action that is being taken to correct the problems.
8. Lends professional and technical assistance to the Benefit Technician, Configuration Supervisor, Plan Document Analysts as well as other AMISYS configuration team staff.


Skills, Knowledge and Abilities

• Thorough knowledge of the configuration and functionality of the AMISYS benefit subsystem.  
• Ability to interpret Summary Plan Descriptions for self-funded and fully insured groups.
• Ability to develop and implement effective solutions for complex and large scale configuration enhancements.
• Strong analytical and research skills including the ability to analyze a problem and develop a solution.
• Strong planning, project management, time management, and organizational skills.
• Strong oral and written communication skills.
• Ability to establish goals and objectives and plan methods to achieve these goals.
• Ability to work independently with little or no supervision.
• Ability to work in teams, both as a team member and as a team leader.
• Ability to effectively facilitate a workgroup or meeting.
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