Quality Assurance Analyst

BlueCross BlueShield of South Carolina•Florence, SC

1d•Onsite

About The Position

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. Description 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. What You Will 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

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
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

Nice To Haves

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

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

Benefits

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 healthy lifestyle premium discount
Tuition assistance
Service recognition
Incentive Plan
Merit Plan
Continuing education funds for additional certifications and certification renewal