Quality Assurance Analyst

001 BlueCross and BlueShield of South Carolina; Florence (SC); Vor Ort; USD 40.000 - 56.000; Vollzeit

Benefits dieser Stelle

Subsidized health plans

401k retirement savings

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Analytical

Customer service

Organization skills

Business math

Ausbildung

High School Diploma or equivalent

Tools

Microsoft Office

Jobbeschreibung

Summary

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 role is full time M-F 8am-5pm, onsite at our Florence, SC location.

Government Clearance

This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

SCA Benefit Requirements

BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Job 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

• 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


• Required Software and tools: Microsoft Office


• 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. Strong business math proficiency. Able to document problems and assist in their resolution. Able to document processes and identify areas for improvement. Strong written and verbal communication skills.

Preferred Qualifications

• 1 year-of experience in a healthcare or insurance industry.

Benefits Overview

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.

Benefits Package

• 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 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 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.

Special Assistance

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.

E-Verify and Pay Transparency

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Additional Information

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Welcome Here's Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we're stronger than ever. Our A.M. Best rating is A+ (Superior) - making us the only health insurance company in South Carolina with that rating. We're 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

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.

Join Us If you're ready to join in a diverse company with secure, community roots and an innovative future.