Summary
 

Performs quality control audits to evaluate accuracy and effectiveness of departmental operations functions including, but not limited to, claims, membership, benefit files, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements

Description
 

Logistics: This full-time (40 hours/week) position is located at 160 North Dozier Blvd. in Florence, SC, and is open Monday through Friday.

***Current C2/TRICARE Security Clearance required or ability to obtain one***

What You'll Do:

• 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.

To Qualify for This Position, You'll Need:

Required Education:

• A High School Diploma or equivalent.

Required Work Experience:

• 1 year of related claims processing, customer service, auditing, training, analysis or operations experience.

• 2 years of experience performing quality audits.

Required Skills and Abilities:

• 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.

We Prefer You to Have:

• Strong proficiency with Excel and Access.

• Prior experience with PGBA.

• Knowledge of BlueCross systems such as CMMS.

What Blue Can Do for You:

Our comprehensive benefits package includes:

• 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 a healthy lifestyle premium discount