Quality Assurance Analyst

BlueCross BlueShield of South Carolina • Columbia, SC

1d • Hybrid

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. This role is full time M-F 8am-5pm, at our Columbia, SC location. Onsite for the first 90 days with opportunity to go hybrid after.

Requirements

• High School Diploma OR equivalent
• One (1) year of related claims processing, customer service, auditing, training, analysis, or operations experience
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED