Quality Assurance Analyst

BlueCross BlueShield of South Carolina•Columbia, 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 position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 7:30AM-5:00PM. It may be necessary, given the business' needs, to work occasional overtime.This role is located at 17 Technology Circle, Columbia, SC 29203. What You’ll 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

High School Diploma or equivalent
1-year of related claims processing, customer service, auditing, training, analysis, or operations experience.
Knowledge of 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.

Nice To Haves

1-year of experience in the 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.