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 remote, full time M-F 8am-5pm.

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 document processes and identify areas for improvement

• Strong written and verbal communication skills

What We Prefer:

• 1-2 years auditing, claims processing, or customer service experience

What We Can Do for You:

• 401(k) retirement savings plan with company match

• Subsidized health plans and free vision coverage

• Life insurance

• Paid annual leave – the longer you work here, the more you earn

• Nine paid holidays