Summary
 

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.

Description
 

Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This remote position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 7:00AM-6:00PM.

• 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’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 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: Advanced knowledge of 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.

We Prefer That You Have the Following:

• Preferred Work Experience:

  • Experience in the NPE West department.

  • Experience working with Provider Enrollment.

  • Experience working with Medicare and/or MAC programs.

• Preferred Software and Other Tools: Experience working with iFlow and PECOS.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits 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 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.

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 mycareer.help@bcbssc.com 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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