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 various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Description
 

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.

Location:

Florence, SC (Onsite)

What You'll Do:

• Conducts focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Documents findings of analysis and prepares recommendations for implementation of new systems, procedures, or organizational changes to reduce errors.
• Identifies areas of weakness and communicates recommendations on changes and improvements to training materials. Provides feedback to management on errors detected, ensures errors are resolved, and provides long-range solutions to causes. Develops and implements a quality control and improvement program based on targets identified through the quality reviews. Monitors and evaluates the implementation of corrective action plans.
• Compiles data, provides feedback, and generates reports for operations and/or training areas on quality performance. Trains new employees and remains current with all guideline changes, work instructions, etc. Writes or assists in writing desk procedures and training materials for departments.
• Provides assistance with special projects such as testing for new business implementation or system changes, reviewing change requests, interpreting department workload, statistical reports, assisting co-workers, etc.

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

Required Education:

• High School Diploma or equivalent

Required Work Experience:

• One year of related claims processing, customer service, auditing, training, analysis, or operations experience
• Two years of experience performing quality audits.

Required Skills and Abilities:

• Strong analytical, presentation, customer service, persuasion, and organization skills
• Strong business math proficiency
• Able to document processes and identify areas for improvement
• Effective written and verbal communication skills
• Microsoft Office to include strong proficiency with Excel creating data tables and using formulas, etc.

We Prefer That You Have The Following:

• One year of experience in a healthcare or insurance industry
• Experience with auditing calls and claims

Our comprehensive benefits package includes the following:

• 401(k) retirement savings plan with company match
• Fantastic health plans and free vision coverag