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SalarySummary 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
Location:
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Description
Location:
4101 Percival Road
Columbia, SC 29229-8320
United States of America
Columbia, SC 29229-8320
United States of America
**Onsite for 6-12months before transitioning to WFH
What You'll Do:
- Perform routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
- Recognize and documents any potential fraud and abuse situations.
- 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.
- Compile data and generates reports for operations areas on quality performance.
- Identify areas of weakness and communicates recommendations on changes and improvements to training materials.
- Document findings of analysis and prepares recommendations for implementation of new systems, procedures or organizational changes.
- Assist with training documentation and development of new processes and procedures.
- Remains current with all guidelines, work instructions, etc.
Work Environment: Typical office environment.
To Qualify for This Position, You'll Need:
- Required Education: High School Diploma or equivalent.
- Required Work Experience: 1 year of related claims processing, customer service, auditing, training, analysis, or operations experience.
- Required Software and Tools: Microsoft Office.
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.
We Prefer That You Have The Following:
- Medicaid or commercial claims experience
- 1 year-of experience in a healthcare or insurance industry.
Our comprehensive benefits package includes the following:
- 401(k) retirement savings plan with company match
- Fantastic 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 significant locations
- Wellness programs and a healthy lifestyle premium discount
- Tuition assistance
- Service Recognition
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.
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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 mycareer.help@bcbssc.com 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.
