BlueCross BlueShield of South Carolina
Analyst, Senior Quality Assurance
BlueCross BlueShield of South Carolina, Myrtle Beach, South Carolina, United States, 29588
SummaryWhy 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 various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!Description
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.
Location:
Myrtle Beach, SC (Onsite)
What You'll Do:Conducts focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Documents findings of analysis and prepares recommendations for implementation of new systems, procedures, or organizational changes to reduce errors.Identifies areas of weakness and communicates recommendations on changes and improvements to training materials. Provides feedback to management on errors detected, ensures errors are resolved, and provides long-range solutions to causes. Develops and implements a quality control and improvement program based on targets identified through the quality reviews. Monitors and evaluates the implementation of corrective action plans.Compiles data, provides feedback, and generates reports for operations and/or training areas on quality performance. Trains new employees and remains current with all guideline changes, work instructions, etc. Writes or assists in writing desk procedures and training materials for departments.Provides assistance with special projects such as testing for new business implementation or system changes, reviewing change requests, interpreting department workload, statistical reports, assisting co-workers, etc.To Qualify for This Position, You'll Need the Following:
Required Education:
High School Diploma or equivalentRequired Work Experience:
One year of related claims processing, customer service, auditing, training, analysis, or operations experienceTwo years of experience performing quality audits.Required Skills and Abilities:
Strong analytical, presentation, customer service, persuasion, and organization skillsStrong business math proficiencyAble to document processes and identify areas for improvementEffective written and verbal communication skillsMicrosoft Office to include strong proficiency with Excel creating data tables and using formulas, etc.We Prefer That You Have The Following:
One year of experience in a healthcare or insurance industryExperience with auditing calls and claimsOur comprehensive benefits package includes the following:
401(k) retirement savings plan with company matchFantastic health plans and free vision coverageLife insurancePaid annual leave - the longer you work here, the more you earnNine paid holidaysOn-site cafeterias and fitness centers in significant locationsWellness programs and a healthy lifestyle premium discountTuition assistanceService Recognition
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
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 conduct 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.help@bcbssc.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.
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.
Location:
Myrtle Beach, SC (Onsite)
What You'll Do:Conducts focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Documents findings of analysis and prepares recommendations for implementation of new systems, procedures, or organizational changes to reduce errors.Identifies areas of weakness and communicates recommendations on changes and improvements to training materials. Provides feedback to management on errors detected, ensures errors are resolved, and provides long-range solutions to causes. Develops and implements a quality control and improvement program based on targets identified through the quality reviews. Monitors and evaluates the implementation of corrective action plans.Compiles data, provides feedback, and generates reports for operations and/or training areas on quality performance. Trains new employees and remains current with all guideline changes, work instructions, etc. Writes or assists in writing desk procedures and training materials for departments.Provides assistance with special projects such as testing for new business implementation or system changes, reviewing change requests, interpreting department workload, statistical reports, assisting co-workers, etc.To Qualify for This Position, You'll Need the Following:
Required Education:
High School Diploma or equivalentRequired Work Experience:
One year of related claims processing, customer service, auditing, training, analysis, or operations experienceTwo years of experience performing quality audits.Required Skills and Abilities:
Strong analytical, presentation, customer service, persuasion, and organization skillsStrong business math proficiencyAble to document processes and identify areas for improvementEffective written and verbal communication skillsMicrosoft Office to include strong proficiency with Excel creating data tables and using formulas, etc.We Prefer That You Have The Following:
One year of experience in a healthcare or insurance industryExperience with auditing calls and claimsOur comprehensive benefits package includes the following:
401(k) retirement savings plan with company matchFantastic health plans and free vision coverageLife insurancePaid annual leave - the longer you work here, the more you earnNine paid holidaysOn-site cafeterias and fitness centers in significant locationsWellness programs and a healthy lifestyle premium discountTuition assistanceService Recognition
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
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 conduct 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.help@bcbssc.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.