Quality Management Professional

2 weeks ago

Columbia, South Carolina, United States BlueCross BlueShield of South Carolina Full time

Job Summary:

We are seeking a highly skilled Quality Assurance Coordinator to join our team at BlueCross BlueShield of South Carolina. As a key member of our quality management team, you will be responsible for ensuring the highest level of quality in our operations.

Key Responsibilities:

  • Assigns, monitors, and audits the work of quality audit staff to ensure compliance with company policies and procedures.
  • Monitors workloads, generates work samples, analyzes outputs for timeliness and quality, and ensures audit and performance deadlines are met.
  • Serves as a subject matter expert and primary point of contact for coordination of quality assurance activities.
  • Represents quality assurance on workgroups and in meetings to ensure effective communication and collaboration.
  • Assumes managerial tasks as needed and acts in a backup capacity to ensure continuity of operations.
  • Develops work plans, objectives, priorities, methods, and procedures to improve quality performance and identify areas for improvement.
  • Writes, updates, and maintains all work instructions to ensure clarity and consistency.
  • Creates reporting methodologies to analyze and measure the effectiveness of implemented improvements.
  • Uses data to identify and implement qualitative and quantitative improvements focusing on prevention, planning, and quality control.
  • Provides training for quality audit staff to ensure they have the necessary skills and knowledge to perform their duties effectively.
  • Conducts quality targeted audits for all designated areas of responsibility as needed, including those of a complex nature.
  • Enters quality results and data into various databases and presents audit findings to customers.
  • Negotiates errors and handles rebuttals to ensure customer satisfaction.
  • Completes monthly quality reporting for customers, trend analysis, and other relevant metrics.
  • Maintains effective ongoing communication with all departments and their management, including task forces for implementation of process improvements.
  • Actively participates in calibration sessions, meetings, conference calls, and training to stay up-to-date on industry best practices.
  • Provides leadership and support for the quality management system by gathering, synthesizing, and presenting information to all levels of division management for the purpose of determining feasibility of proposed changes.

Requirements:

  • Bachelor's degree or equivalent work experience.
  • 1 year of quality assurance experience.
  • Microsoft Office proficiency.
  • Demonstrated leadership skills.
  • Strong analytical, presentation, customer service, persuasion, and organization skills.
  • Advanced business math proficiency.
  • Able to document problems and assist in their resolution.
  • Able to document processes and identify areas for improvement.
  • Excellent written and verbal communication skills.
  • Ability to produce written documentation and summarize for management level.

Preferred Qualifications:

  • ACA experience.
  • Medicare advantage experience.
  • Insurance sales experience.

Our Benefits:

  • 401(k) retirement savings plan with company match.
  • Fantastic health plans and free vision coverage.
  • Life insurance.
  • Paid annual leave.
  • Nine paid holidays.
  • On-site cafeterias and fitness centers.
  • Wellness programs and a healthy lifestyle premium discount.
  • Tuition assistance.
  • Service Recognition.

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