Quality Assurance Analyst

BlueCross BlueShield of South Carolina•Florence, SC

1d•Onsite

About The Position

Under direct supervision, the Quality Assurance Analyst performs quality control audits, reviews, and monitoring of departmental operations, including claims, membership, customer service and call center functions, workflow, processing support systems, procedures, and documentation. The role identifies problems, analyzes causes and effects, and recommends improvements. This is a full-time, onsite position at the Florence, South Carolina location, with a Monday–Friday schedule from 8 a.m. to 5 p.m. The position requires the ability to obtain a security clearance, which requires U.S. citizenship. As the employer’s federal contracts are subject to the Service Contract Act, employees cannot opt out of health benefits; supplemental pay is provided until enrollment in health benefits 28 days after the hire date. The successful candidate performs routine quality reviews, documents potential fraud and abuse, provides feedback and coaching, reports on quality performance, recommends improvements to training and procedures, documents analysis and implementation recommendations, and assists with training documentation and process development. The role requires a high school diploma or equivalent, one year of related experience, and Microsoft Office skills. Healthcare or insurance industry experience is preferred. Eligible employees may participate in the benefits program beginning the first of the month following 28 days of employment. The employer describes opportunities for employees to develop skills, advance their careers, and contribute to company growth.

Requirements

High school diploma or equivalent.
One year of related claims processing, customer service, auditing, training, analysis, or operations experience.
Microsoft Office skills.
Good analytical, customer service, and organizational skills.
Basic business math proficiency; the description also specifies strong business math proficiency.
Ability to document problems and assist in their resolution.
Ability to document processes and identify areas for improvement.
Effective written and verbal communication skills; the description also specifies strong written and verbal communication skills.
Ability to obtain a security clearance; applicants must be U.S. citizens.

Nice To Haves

One year of experience in the healthcare or insurance industry.

Responsibilities

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

Benefits

Subsidized health plans
Dental coverage
Vision coverage
401(k) 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
Supplemental pay until enrollment in health benefits 28 days after the hire date, as described under SCA benefit requirements