Senior Quality Assurance Analyst PGBA

  • Anywhere

Company :
BlueCross BlueShield of South Carolina

Location :
Florence, South Carolina

Expiry Date :
Tue, 15 Jun 2021 23:59:59 GMT

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Description :
Internal Reference Number: R SummaryPerforms quality control audits to evaluate accuracy and effectiveness 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 – 35% Conducts focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Documents findings of analysis and prepares recommendations for implantation of new systems, procedures, or organizational changes to reduce errors. – 35% Identifies areas of weakness and communicates recommendations on changes and improvements to training materials. Provides feedback to management on errors detected, ensures errors are resolved, and provides long-range solutions to causes. Develops and implements a quality control and improvement program based on targets identified through the quality reviews. Monitors and evaluates the implementation of corrective action plans. – 20% Compiles data, provides feedback, and generates reports for operations and/or training areas on quality performance. Trains new employees and remains current with all guideline changes, work instructions, etc. Writes or assists in writing desk procedures and training materials for departments. – 10% Provides assistance with special projects such as testing for new business implementation or system changes, reviewing change requests, interpreting department workload, statistical reports, assisting co-workers, 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 in health care/health insurance environment – Two years of experience performing quality audits in a healthcare/health insurance environment 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 Required Software and Tools: – Microsoft Office with strong proficiency in Excel and Access 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 e-mail or call 1-, 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.