Summary

Palmetto GBA is one of the nation’s largest providers of high-volume claims and transaction processing, contact center operations, and technical services to the federal government and other commercial customers. Our core business is providing services to CMS Medicare beneficiaries, providers, and health plans. Our team leads the organization’s statistics, data analysis, and research functions. We support strategic decision making by delivering high quality analytics, actionable insights, and data driven recommendations. We work closely with cross functional partners to improve performance, measure outcomes, and strengthen organizational learning. Our culture is collaborative, curious, and mission driven. We value analytical rigor, integrity, and continuous improvement. Team members support each other through open communication, shared problem solving, and a commitment to professional growth. We encourage creativity in methodological approaches, welcome diverse perspectives, and maintain a positive and respectful work environment.

Description Logistics:

Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.

Position Purpose:

Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings.

What You’ll Do:

• Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and ad hoc reporting.
• Creates supporting documentation outlining all procedures within scope of responsibility.
• Develops complex sampling design and/or execution methodology for sample selection.
• Develops difficult statistical analysis using standard reporting, ad hoc reporting, and data mining tools.
• Provides sophisticated data interpretation, compilation, and verification to guide departmental efforts.
• Prepares charts, illustrations, and other graphics and narrative reports to identify and explain patterns and trends.
• Participates in writing of articles suitable for internal/external publication to support departmental efforts. May assume a leadership role in this activity.
• Provides assistance in development of project plans and system life cycle maintenance, performing quality checks on relational database tables, and in the development of focused end-user applications.
• With leadership responsibilities as assigned by management, participates in development of change requests and testing plans for changes to existing relational database tables.
• Researches new sources of data and provides written and/or verbal feedback to management.

To Qualify for This Position, You’ll Need the Following:

Required Education:

Bachelor's in a job related field

Required Work Experience:

Four years statistical programming or statistical interpretation.

Required Skills and Abilities:

• Strong organizational, customer service, and analytical skills.
• Ability to use complex mathematical calculations.
• Demonstrated knowledge of mathematical or statistical concepts.
• Relevant computer programming skills.

Required Software and Tools:

Microsoft Office.

We Prefer That You Have the Following:

• Experience with Prior Auth programs and Review Choice Demonstration reporting.
• Python experience
• Develop and maintain SAS programs for analyzing Medicare claims data and identifying trends in medical claims.
• Conduct data extraction, manipulation, and validation using PROC SQL, PROC REPORT, PROC TABULATE, and macro programming.
• Code, maintain, and execute database programs for the extraction and presentation of data for standard and ad hoc reporting.
• Develop supporting material and guidelines on report design and resulting data.
• Perform statistical analysis and hypothesis testing for fraud detection and risk assessment.
• Ensure compliance with industry standards, data integrity, and regulatory reporting requirements.
• Collaborate with cross-functional teams to optimize reporting workflows and develop submission-ready datasets.
• Good oral and written communication skills.
• Computer systems support knowledge.
• SAS, Business Objects, and/or DB2 or other relational database.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. Our comprehensive benefits package includes: Subsidized health plans, dental and vision coverage 401K retirement savings plan with company match Life Insurance Paid Time Off (PTO) Nine paid holidays On-site cafeterias and fitness centers in major locations Wellness program and healthy lifestyle premium discount Tuition assistance Service recognition Employee Assistance Discounts to movies, theaters, zoos, theme parks and more.

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 our 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.