Senior Quality Assurance Analyst

BlueCross BlueShield of South Carolina•Myrtle Beach, SC

21h•Onsite

About The Position

Performs quality control audits to evaluate accuracy and effectiveness 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

Requirements

A High School Diploma or equivalent
1 year of related claims processing, customer service, auditing, training, analysis or operations experience, 2 years of experience performing quality audits.
Strong analytical, presentation, customer service, persuasion, and organization skills.
Strong business math proficiency.
The ability to document problems and assist in their resolution.
The ability to document processes and identify areas for improvement.
Strong written and verbal communication skills.
Knowledge of Microsoft Office applications.

Nice To Haves

Strong proficiency with Excel and Access.
Prior experience with PGBA.
Knowledge of BlueCross systems such as CMMS.

Responsibilities

Conduct focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
Document findings of analysis and prepare recommendations for implantation of new systems, procedures, or organizational changes to reduce errors.
Identify areas of weakness and communicate recommendations on changes and improvements to training materials.
Provide feedback to management on errors detected, ensure errors are resolved, and provide long-range solutions to causes.
Develop and implement a quality control and improvement program based on targets identified through the quality reviews.
Monitor and evaluate the implementation of corrective action plans.
Compile data, provide feedback, and generate reports for operations and/or training areas on quality performance.
Train new employees and remains current with all guideline changes, work instructions, etc.
Write or assist in writing desk procedures and training materials for departments.
Provide assistance with special projects such as testing for new business implementation or system changes, review change requests, interpret department workload, statistical reports, assist co-workers, etc.