PE QC & Training Lead-2

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health plans

401k retirement savings with company 3

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a senior-level professional to improve provider data quality by auditing the work of Enrollment Analysts. The role develops reports to inform management about data quality trends, and trains analysts in PIMS and departmental procedures.

It requires evaluating training needs and maintaining QC protocols. The position is full-time onsite in Columbia, SC, with potential overtime and travel between buildings.

Qualifications

• Bachelor's Degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.
• 2 years of provider network enrollment/certification experience.

Responsibilities

• Reviews provider data to ensure accuracy.
• Develops reporting tools to keep management abreast of any data error trends or issues.
• Works with the supervisor to address individual errors.
• Develops and maintains departmental quality control protocol and policy and procedure manuals ensuring any changes are properly communicated.
• Trains new analysts on PIMS and departmental policies and procedures.
• Conducts training needs analysis based on quality control results.
• Recommends training materials and subject matter to management.
• Serves as a resource to analysts with difficult or escalated issues.

Skills

Data quality

Reporting tools

Training & development

Quality control

Education

Bachelor's Degree equivalency

Tools

PIMS system

Enrollment data systems

Job description

Summary

Senior level position focused on improving provider data quality by auditing the work of Provider Enrollment Analysts and Senior Provider Enrollment Analysts. Develops reports to keep management informed of the overall quality control of Provider Information Management Systems (PIMS). Performs training needs assessments and recommends training courses based on issues found during the quality control process. Provides training to new analysts and ongoing developmental training to the department.

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but we’re part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Sponsorship

This position is not eligible for sponsorship now or in the future.

Description Logistics

BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 7:00AM - 5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 4101 Percival Road, Columbia, SC 29229.

What You’ll Do

• Reviews provider data to ensure accuracy.
• Develops reporting tools to keep management abreast of any data error trends or issues.
• Works with the supervisor to address individual errors.
• Develops and maintains departmental quality control protocol and policy and procedure manuals ensuring any changes are properly communicated.
• Trains new analysts on PIMS and departmental policies and procedures.
• Conducts training needs analysis based on quality control results.
• Recommends training materials and subject matter to management.
• Serves as a resource to analysts with difficult or escalated issues.

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

Required Education

Bachelor's Degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

Required Work Experience

2 years of provider network enrollment/certification experience.

Our Comprehensive Benefits Package Includes The Following

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

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 the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Veterans Welcome

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.

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 [e-mail] 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.