Quality Assurance Analyst - Claims & Operations

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 42,000 - 52,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan

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 Quality Control/ Audit professional to perform routine audits across departments, identify issues, and recommend improvements. The role involves monitoring processes, documenting findings, and providing coaching to raise performance and compliance levels.

The position requires at least a high school diploma and about one year of related experience in claims processing, customer service, auditing, or analysis.

Qualifications

• High School Diploma or equivalent.
• 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.
• Good analytical, customer service, and organization skills.

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.

Skills

Analytical skills

Customer service

Organization

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Quality Control/ Audit professional to perform routine audits across departments, identify issues, and recommend improvements. The role involves monitoring processes, documenting findings, and providing coaching to raise performance and compliance levels.

The position requires at least a high school diploma and about one year of related experience in claims processing, customer service, auditing, or analysis.