Senior Quality Assurance Analyst - PGBA

Summary
 Perform quality control audits to evaluate the accuracy and effectiveness of departmental operations functions, including claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identify problems, analyze cause and effect, and make recommendations for improvements.
Description
 

Location: This role is onsite at 300 N Dozier Blvd, Florence, SC 29501.

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'll Do:

• Conduct focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are followed. Document analysis findings and prepare recommendations for implementing new systems, procedures, or organizational changes to reduce errors.

• Identify weaknesses and communicate recommendations on changes and improvements to training materials. Provide feedback to management on errors detected, ensure errors are resolved, and provide long-range solutions to causes. Develop and implement a quality control and improvement program based on targets identified through the quality reviews. Monitor and evaluate the implementation of corrective action plans.

• Compile data, provide feedback, and generate reports on quality performance for operations and/or training areas. Train new employees and remain current with all guideline changes, work instructions, etc. Writes or assists in writing desk procedures and training materials for departments.

• Assist with special projects such as testing for new business implementation or system changes, reviewing change requests, interpreting department workload, and statistical reports, assisting co-workers, etc.

To Qualify for This Position, You'll Need the Following:

• Required Education: High School Diploma or equivalent

• Required Experience: One (1) year of related claims processing, customer service, auditing, training, analysis or operations experience. Two (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.

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

• Wellness program and healthy lifestyle premium discount

• Tuition assistance

• Service Recognition

• Employee Assistance

• 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. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

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

Some states have required notifications. Here's more information. 

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.