QA Analyst – Healthcare & Claims Operations

001 BlueCross and BlueShield of South Carolina; Florence (SC); Presencial; USD 40 000 - 56 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Subsidized health plans

401k retirement savings

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Resumo da oferta

BlueCross BlueShield of South Carolina in Florence, SC seeks a Quality Control Auditor to perform audits, reviews, and monitoring across operations such as claims and customer service. You will identify issues, analyze causes, and recommend improvements while ensuring adherence to procedures and training standards.

The role requires at least 1 year in related fields, strong analytical and communication skills, and proficiency with Microsoft Office.

Qualificações

• Required Education: High School Diploma OR equivalent.
• Required Work Experience: One (1) year of related claims processing, customer service, auditing, training, analysis, or operations experience.

Responsabilidades

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

Conhecimentos

Analytical

Customer service

Organization skills

Business math

Formação académica

High School Diploma or equivalent

Ferramentas

Microsoft Office

Descrição da oferta de emprego

BlueCross BlueShield of South Carolina in Florence, SC seeks a Quality Control Auditor to perform audits, reviews, and monitoring across operations such as claims and customer service. You will identify issues, analyze causes, and recommend improvements while ensuring adherence to procedures and training standards.

The role requires at least 1 year in related fields, strong analytical and communication skills, and proficiency with Microsoft Office.