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.
Location
This role is full time M-F 8am-5pm, at our Columbia, SC location. Onsite for the first 90 days with opprotunity to go hybrid after.
Responsibilities
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
To Qualify for This Position, You Will Need:
Required Education: High School Diploma OR equivalent
Required Work Experience: One (1) year of related claims processing, customer service, auditing, training, analysis, or operations experience
Required Software and tools: Microsoft Office
What We Prefer:
1 year-of experience in a healthcare or insurance industry.
What We Can Do for You:
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 healthy lifestyle premium discount
Tuition assistance
Service recognition
Incentive Plan
Merit Plan
Continuing education funds for additional certifications and certification renewal
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 a 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.
Equal Employment Opportunity Statement
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 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.
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Ourhrconnect · Columbia, SC