Quality Assurance Analyst

Internal Reference Number: R1049864
Summary 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.Description

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

Required Education:

• High School Diploma or equivalent

Required Work Experience:

• One year of related claims processing, customer service, auditing, training, analysis, or operations experience
• Experience with auditing

Preferred Work Experience:

• One year-of experience in a healthcare or insurance industry
• Experience with audition calls and claims

Required Skills and Abilities:

• 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 to include strong proficiency with Excel creating data tables, using formulas, etc.

Work Environment:

• Typical office environment

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 disabilitiesand 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.

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