Summary
 

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.

Description
 

Location: This full-time (40 hours/week) position is located in Myrtle Beach, SC.

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

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 lon