Quality Assurance Analyst

ourhrconnect; Columbia (SC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement

Life Insurance

Paid Time Off

On-site cafeterias

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Quality Control Auditor to perform routine audits and monitoring across departments such as claims, membership, and customer service. You will identify issues, document findings, and support improvements in processes and training.

This role requires a keen eye for detail and strong communication. Located in Columbia, SC, the position is full-time with standard hours and occasional overtime.

Qualifications

• High School Diploma or equivalent required.
• 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.
• Strong analytical, customer service, and organizational skills.
• Basic business math proficiency.
• Ability to document problems and assist in their resolution.
• Ability to document processes and identify areas for improvement.
• Excellent written and verbal communication skills.

Responsibilities

• Perform routine quality audits and monitoring across operations to ensure standards.
• Recognize and document potential fraud and abuse; guide new hires after training.
• Provide feedback to operations and training; compile quality performance reports.
• Identify weaknesses and recommend updates to training materials and processes.
• Assist with training documentation and development of new processes.

Skills

Analytical skills

Customer service

Organization

Business math

Problem documentation

Process documentation

Communication skills

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been 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!

Description

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.

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.

What You’ll Do:

• 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.

To Qualify For This Position, You'll Need The Following:

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.

We Prefer That You Have The Following:

Preferred Work Experience:

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

Our Comprehensive Benefits Package Includes The Following:

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

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.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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 disabilitiesand 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. Here's moreinformation.

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