Analyst, Quality Assurance - BlueCross BlueShield of South Carolina

Why 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. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re 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 a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Job Title: Analyst, Quality Assurance

Position Notes:

• Work Schedule: Monday-Friday 8:30am - 4:30pm
• Contract to Perm
• Interviews are done in person, Monday through Friday, 9:30 to 11:00am at Percival Rd.
• This position is onsite 4 weeks, no option for remote work.
• Perform Quality Control quality audits to evaluate accuracy on claims, customer service and provider service calls, recons and appeals, refunds.
• Good communication, ability to multitask, be present, ability to switch tasks with accuracy.
• Team consists of three areas-Audit, Refund, Quality Control and comprised of 12 people, our teams work on claims investigation, workflow activities, and audits.
• This candidate needs to have strong communication skills, research skills, analytical skills, customer service skills, needs health insurance background.

Duties:

• 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.
• 50% 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.
• 20% 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.
• 20% 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.
• 10% Assists with training documentation and development of new processes and procedures. Remains current with all guidelines, work instructions, etc.

Required Skills and Abilities:

• Required Education: High School Diploma or equivalent
• Required Work Experience: 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.
•  Preferred Work Experience: 1 year-of experience in a healthcare or insurance industry.
• 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.
• Required Software and Other Tools: Microsoft Office.
• Work Environment: Typical office environment.

This is the pay range that Magnit reasonably expects to pay someone for this position is $11.25/hour - $15.00/hour. Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met).

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. 

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!