Summary
 

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 hybrid 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 8:30AM-5:00PM. It may be necessary, given the business need 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.

To Qualify for This Position, You'll Need the Following:

• Required Education: High School Diploma or equivalent.

• Required Work Experience: 1-year of related claims processing, customer service, auditing, training, analysis, or operations experience.

• Required Software and Tools: Knowledge of Microsoft Office.

• Required Skills and Abilities:

  • 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.

We Prefer That You Have the Following:

• 1 year-of experience in a healthcare or insurance industry.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the