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:

As a member of our Quality Assurance team, you will be under direct supervision and will perform quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation. Your analytical skills will be used to identify problems, analyze cause and effect and makes recommendation for improvements.

Here is your opportunity demonstrate your customer service, organization skills, and basic business math proficiency; document problems and assist in their resolution; document problems and assist in their resolution.
 

Logistics:

This position is full-time (40 hours/week, 8 hours/day) Monday – Friday in a typical office environment. This role is onsite at 4101 Percival Road in Columbia, SC. Remote work/flexible work arrangement possible after training is complete and performance standards are being met.

What You'll Do:

• Perform routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
• Recognize and document any potential fraud and abuse situations. May provide one on one guidance to new hires upon completion of initial training.
• Provide necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed. Compile data and generate reports for operations areas on quality performance.
• Identify areas of weakness and communicate recommendations on changes and improvements to training materials. Document findings of analysis and prepare recommendations for implementation of new systems, procedures or organizational changes.
• Assist with training documentation and development of new processes and procedures. Remain current with all guidelines, work instructions, 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.

Required Skills and Abilities:

• Good analytical, customer service, and organization skills.
• Basic business math proficiency.
• The ability to document problems and assist in their resolution.
• The ability to document processes and identify areas for improvement.
• Effective written and verbal communication skills.
• Knowledge of Microsoft Office applications.

We Prefer You to Have:

Preferred Wo