Insurance QA Analyst: Claims & Operations

Southcarolinablues; Columbia (SC); On-site; USD 40,000 - 60,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking a Quality Assurance Analyst to perform routine audits and monitoring across claims, service and operations. You will identify issues, document fraud indicators, provide coaching, and compile performance reports to support continuous improvement.

The role is on-site in Columbia, SC with typical business hours and occasional overtime. Applicants should have at least 1 year of related experience, strong written and verbal communication, basic math

Qualifications

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

Responsibilities

• Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards.
• Recognizes and documents potential fraud and abuse situations.
• Provides necessary feedback or coaching to operations and training areas on errors assessed.
• Compiles data and generates reports for operations areas on quality performance.
• Identifies areas of weakness and communicates recommendations on changes and improvements to training materials.
• Documents findings and prepares recommendations for implementation of new systems, procedures or organizational changes.
• Assists with training documentation and development of new processes and procedures.

Skills

Analytical skills

Customer service

Organization

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Quality Assurance Analyst to perform routine audits and monitoring across claims, service and operations. You will identify issues, document fraud indicators, provide coaching, and compile performance reports to support continuous improvement.

The role is on-site in Columbia, SC with typical business hours and occasional overtime. Applicants should have at least 1 year of related experience, strong written and verbal communication, basic math