Analyst, Quality Assurance - Request #37661091

Southcarolinablues; Columbia (SC); On-site; USD 21,000 - 22,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401K

Job summary

BlueCross BlueShield of South Carolina is seeking an Analyst, Quality Assurance to join our on-site team in Columbia. Under supervision, you will perform quality audits, reviews, and monitoring across claims, membership, and customer service operations, identifying issues and recommending improvements.

Requires a High School Diploma or equivalent and at least 1 year of related claims processing, customer service, auditing, or analysis experience.

Qualifications

• 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.

Responsibilities

• Performs routine quality audits and monitoring across operations to ensure standards are met.
• Recognizes and documents potential fraud and abuse situations.
• Provides guidance to new hires after training completion.
• Compiles data and generates reports on quality performance.

Skills

Analytical skills

Customer service

Organizational skills

Basic math

Documentation

Communication

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

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. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) - making us the only health insurance company in South Carolina with that rating. We’re 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.

Job Title: Analyst, Quality Assurance

Position Details

• CONTRACT TO HIRE SCHEDULE IS M-F 8:00-4:30. CAN ACCOMMODATE 7:30-4:00 OR 8:30-5:00. ONSITE INTERVIEWS WILL BE CONDUCTED TRAINING WILL BE 2-3 WEEKS. ONSITE POSITION ONLY - MUST BE LOCAL CANDIDATES 2-4 PREFERRED/NICE TO HAVE skill sets/qualities: Microsoft Office Skills Soft Skills: Detail Oriented - to be able to be organized and able to complete tasks as assigned

Position Summary

Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements.

Essential Duties and Responsibilities

50%

• Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
• Recognizes and documents any potential fraud and abuse situations.
• May provide one on one guidance to new hires upon completion of initial training.

20%

• Provides necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed.
• Compiles data and generates reports for operations areas on quality performance.

20%

• Identifies areas of weakness and communicates recommendations on changes and improvements to training materials.
• Documents findings of analysis and prepares recommendations for implementation of new systems, procedures or organizational changes.

10%

• Assists with training documentation and development of new processes and procedures.
• Remains current with all guidelines, work instructions, etc.

Required Skills and Abilities

• Good analytical, customer service, and organization skills.
• Basic business math proficiency.
• Able to document problems and assist in their resolution.
• Able to document processes and identify areas for improvement.
• Effective written and verbal communication skills.

Required Software and Other Tools

• Microsoft Office.

Work Environment

• Typical office environment.

Required Education

• High School Diploma or equivalent

Required Work Experience

• 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.

Preferred Work Experience

• 1 year of experience in a healthcare or insurance industry.

Pay Transparency

• This is the pay range that Magnit reasonably expects to pay someone for this position is $15.00/hour - $16.00/hour W-2.
• Medical
• Dental
• Vision
• 401K (provided minimum eligibility hours are met).

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.