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
 

Position Purpose

We are currently hiring for a Sr Quality Assurance Analyst, to join BlueCross BlueShield of South Carolina. In this role as a Sr Quality Assurance Analyst, you will perform quality control audits to evaluate the accuracy and effectiveness of departmental operations functions, including claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identify problems, analyze cause and effect, and make recommendations for improvements.

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics

Location: This role is full time M-F 8am-5pm, onsite at our Myrtle Beach location

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 Will Do:

• Conduct focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are followed

• Document analysis findings and prepare recommendations for implementing new systems, procedures, or organizational changes to reduce errors

• Identify weaknesses 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 on quality performance for operations and/or training areas

• Train new employees and remain current with all guideline changes, work instructions, etc. Writes or assists in writing desk procedures and training materials for departments

• Assist with special projects such as testing for new business implementation or system changes, reviewing change requests, interpreting department workload, and statistical reports, assisting co-workers, etc

To Qualify for This Position, You Will Need:

• Required Education: High School Diploma OR equivalent

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

• Two (2) years of experience performing quality audits.

• Required Software and tools: Microsoft Office

• Required Skills and Abilities: Strong analytical, presentation, customer service, persuasion, and organization skills

• Strong business math proficiency

• Able to document problems and assist in their resolution

• Able to documen