Quality Assurance Analyst

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Health plans

Dental & Vision

401k with company match

Life Insurance

PTO

On-site facilities

Education assistance

Service recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Quality Control Auditor to perform routine audits across claims processing, customer service, and related operations. You will identify fraud, coach new hires, and generate quality reports.

The role requires strong analytical and communication skills, with proficiency in Microsoft Office and formal documentation of findings. This full-time position is based in Columbia, SC, offering benefits and opportunities to improve processes and training

Qualifications

• High School Diploma or equivalent required.
• 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.
• Strong analytical skills and ability to communicate effectively in writing and speech.
• Proficiency with Microsoft Office and data documentation.

Responsibilities

• Performs routine quality audits across operations to ensure standards are followed.
• Recognizes and documents potential fraud and abuse situations.
• Provides coaching to new hires after initial training.
• Delivers feedback to improve training and materials.
• Compiles data and generates reports on quality performance.
• Identifies weaknesses and recommends training/material changes.
• Documents findings and proposes new systems or procedures.
• Assists with training documentation and development.
• Stays current with guidelines and work instructions.

Skills

Analytical

Customer service

Organization

Business math

Issue documentation

Process documentation

Written & verbal communication

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Company Overview

Summary 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.

Position Overview

Position Purpose: 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.

Key Responsibilities

• 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.

Requirements and Experience

Required Education

High School Diploma or equivalent

Work Experience

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

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 Tools

Microsoft Office.

Preferred Experience

1 year-of experience in the healthcare or insurance industry.

Benefits

• We offer our employees great benefits and rewards.You will be eligible to participate in our benefits program the first of the month following 28 days of employment. 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

Work Location and Hours

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 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. This role is located at 17 Technology Cir. Columbia, SC 29209. Sponsorship: This position is not eligible for sponsorship now or in the future.

Veterans and Diversity

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.

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.

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.