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
 

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 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

We Prefer That You Have The Following:

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

Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in our benefits program the first of the month following 28 days of employment

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You: We 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.

 

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 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 [email protected] or call 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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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