Quality Assurance Analyst - PGBA

Summary Under direct supervision, performs 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, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Description Logistics: This position is full time (40 hours/week) dayshift 8:00am-5:00 pm Monday-Friday. This role is onsite in Florence, SC. Due to TRICARE security access requirements for this position, the selected candidate must be able to obtain a security clearance which requires US Citizenship. 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'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 communicates recommendations on changes and improvements to training materials. Document findings of analysis and prepares 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: High School Diploma or equivalent. One year of related claims processing, customer service, auditing, training, analysis, or operations experience. 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. Experience with Microsoft Office. We Prefer That You Have: One year-of experience in a healthcare or insurance industry. What Blue Can Do for You: Our comprehensive benefits package includes: 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 a healthy lifestyle premium discount Tuition assistance Service Recognition What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.helpbcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.