Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Description
 

Job Purpose:

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.

Logistics:

This position is full-time (40 hours/week) Monday – Friday.  This position is located onsite at 8733 Highway 17 Bypass in Myrtle Beach, SC.

***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 Blue