Senior Quality Assurance Analysts

001 BlueCross and BlueShield of South Carolina; Florence (SC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health plans

Dental coverage

Vision coverage

401k retirement savings with company-m

Life Insurance

Paid Time Off

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Quality Control Auditor to evaluate the accuracy and effectiveness of departmental operations, including claims, membership, customer service, workflow, and processing systems. You will identify problems, analyze causes, and propose improvements in a fast-paced office in Florence, SC.

The position is full-time, 40 hours per week, Monday–Friday, onsite at our Florence campus.

Qualifications

• Requires High School Diploma or equivalent.
• 1 year of related claims processing, customer service, auditing, training, analysis or operations experience.
• 2 years of experience performing quality audits.

Responsibilities

• Conducts focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
• Documents findings of analysis and prepares recommendations for implementation of new systems, procedures, or organizational changes to reduce errors.
• Identifies areas of weakness and communicates recommendations on changes and improvements to training materials.
• Provides feedback to management on errors detected, ensures errors are resolved, and provides long-range solutions to causes.
• Develops and implements a quality control and improvement program based on targets identified through the quality reviews.
• Monitors and evaluates the implementation of corrective action plans.

Skills

Analytical skills

Presentation

Customer service

Persuasion

Organization

Math proficiency

Documentation

Written communication

Verbal communication

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

Performs quality control audits to evaluate accuracy and effectiveness 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. This role is onsite at 200 North Dozier Boulevard, Florence, SC.

Position Purpose

Performs quality control audits to evaluate accuracy and effectiveness 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.

Sponsorship

This position is not eligible for sponsorship now or in the future.

What You’ll Do

• Conducts focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
• Documents findings of analysis and prepares recommendations for implementation of new systems, procedures, or organizational changes to reduce errors.
• Identifies areas of weakness and communicates recommendations on changes and improvements to training materials.
• Provides feedback to management on errors detected, ensures errors are resolved, and provides long-range solutions to causes.
• Develops and implements a quality control and improvement program based on targets identified through the quality reviews.
• Monitors and evaluates the implementation of corrective action plans.
• Compiles data, provides feedback, and generates reports for operations and/or training areas on quality performance.
• Trains new employees and remains current with all guideline changes, work instructions, etc.
• Writes or assists in writing desk procedures and training materials for departments.
• Provides assistance with special projects such as testing for new business implementation or system changes, reviewing change requests, interpreting department workload, statistical reports, assisting co-workers, etc.

To Qualify For This Position, You’ll Need The Following

• Required Education: High School Diploma or equivalent.
• Required Work Experience: 1 year of related claims processing, customer service, auditing, training, analysis or operations experience.
• 2 years of experience performing quality audits.

Required Skills and Abilities

Strong analytical, presentation, customer service, persuasion, and organization 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.

Required Software and Tools

Microsoft Office.

Work Environment

Typical office environment.

Our Comprehensive Benefits Package Includes The Following

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits 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 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. Here's more information. Some states have required notifications. Here's more information.

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.

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.