Quality Assurance Analyst

Summary

Description

Job Description Summary

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. 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 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!

Job Purpose

As a member of our Quality Assurance team, you will be under direct supervision and will perform 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. Your analytical skills will be used to identify problems, analyze cause and effect and makes recommendation for improvements.

Logistics

This position is full-time (40 hours/week, 8 hours/day) Monday – Friday in a typical office environment. This role is located at 4101 Percival Road in Columbia, SC.

What You'll Do

• Perform routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
• Recognize and document any potential fraud and abuse situations. May provide one on one guidance to new hires upon completion of initial training.
• Provide necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed. Compile data and generate reports for operations areas on quality performance.
• Identify areas of weakness and communicate recommendations on changes and improvements to training materials. Document findings of analysis and prepare recommendations for implementation of new systems, procedures or organizational changes.
• Assist with training documentation and development of new processes and procedures. Remain current with all guidelines, work instructions, etc.
  
  

To Qualify For This Position, You'll Need

• A High School Diploma or equivalent.
• One year of related claims processing, customer service, auditing, training, analysis or operations experience.
• Good analytical, customer service, and organization skills.
• Basic business math proficiency.
• The ability to document problems and assist in their resolution.
• The ability to document processes and identify areas for improvement.
• Effective written and verbal communication skills.
• Knowledge of Microsoft Office applications.
  
  

We Prefer You To Have

• One year of experience in a healthcare or insurance industry.
  
  

What Blue Can Do For You

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave — the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and a healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
  
  

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 [email protected] 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.

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