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
This role is full time M-F 8am-5pm, onsite at our Myrtle Beach, 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:
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
Train 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 Will Need:
Required Education: High School Diploma OR equivalent
Required Work Experience : 1 year of related claims processing, customer service, auditing, training, analysis or operations experience. 2 years of experience performing quality audits
Required Software and tools: Microsoft Office
Required Skills and Abilities: Strong analytical, presentation, customer service, persuasion, and organization 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.
What We Can Do for You:
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
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 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.
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.
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