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
 

Location

This role is full time M-F 8am-5pm, onsite at our Florence, SC 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:

• 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 Will Need:

• Required Education: High School Diploma OR one (1) year of related claims processing, customer service, auditing, training, analysis, or operations experience

• Required Software and tools: 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, 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 year-of experience in a healthcare or insurance industry.

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

• On-site cafeterias and fitness centers in major locations

• Wellness programs and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Incentive Plan

• Merit Plan

• Continuing education funds for additional certifications and certification renewal

What to Expect Next: