Quality Assurance Specialist

3 weeks ago


Florence, Colorado, United States BlueCross BlueShield of South Carolina Full time
Job Summary

We are seeking a highly skilled Quality Assurance Specialist to join our team at BlueCross BlueShield of South Carolina. As a Quality Assurance Specialist, you will be responsible for conducting quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed.

Key Responsibilities
  • Conduct focused quality audits to evaluate accuracy and effectiveness of departmental operations functions
  • Document findings of analysis and prepare recommendations for implementation of new systems, procedures, or organizational changes
  • 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 remain 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.
Requirements
  • A High School Diploma or equivalent
  • 1 year of related claims processing, customer service, auditing, training, analysis or operations experience
  • 2 years of experience performing quality audits
  • 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
Preferred Qualifications
  • Strong proficiency with Excel and Access
  • Prior experience with PGBA
  • Knowledge of BlueCross systems such as CMMS
What We Offer
  • 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


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