Senior Quality Assurance Analyst - PGBA (Surfside)

Job Description Summary:

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. We are 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 Purpose:

Performs quality control audits to evaluate accuracy and effectiveness of departmental operations functions including, but not limited to, claims, membership, benefit files, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements.

Logistics:

This position is full-time (40 hours/week) Monday – Friday.  This position is located onsite at 8733 Highway 17 Bypass in Myrtle Beach, SC.

***Current C2/TRICARE Security Clearance required or ability to obtain one***

What You'll Do:

• Conduct focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Document findings of analysis and prepare recommendations for implantation of new systems, procedures, or organizational changes to reduce errors.
• Identify areas of weakness 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 for operations and/or training areas on quality performance. Train new employees and remains current with all guideline changes, work instructions, etc. Write or assist in writing desk procedures and training materials for departments.
• Provide assistance with special projects such as testing for new business implementation or system changes, review change requests, interpret department workload, statistical reports, assist co-workers, etc.

To Qualify for This Position, You'll Need:

Required Education:

• A 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 Skills and Abilities:

• Strong analytical, presentation, customer service, persuasion, and organization skills.
• Strong business math proficiency.
• The ability to document problems and assist in their resolution.
• The ability to document processes and identify areas for improvement.
• Strong written and verbal communication skills.
• Knowledge of Microsoft Office applications.

We Prefer You to Have:

• Strong proficiency with Excel and Access.
• Prior experience with PGBA.
• Knowledge of BlueCross systems such as CMMS.

What Blue Can Do for You:

Our comprehensive benefits package includes:

• 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 a healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.

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 be conducting 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.

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 call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.