Quality Assurance Analyst

Internal Reference Number: R1048217

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.

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

This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Blue Cross Blue Shield 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.

• 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

• Required
  
  Education:
  
  High School Diploma OR equivalent

• Required
  
  Work Experience:
  
  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

• 1 year-of experience in a healthcare or insurance industry.

• 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

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 a 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.

Blue Cross Blue Shield 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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.helpor call , ext. 47480 with the nature of your request. We will make a…