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BlueCross BlueShield of South Carolina

Health insurance and plan administration

Quality Assurance Coordinator

Business OperationsPosted on Nov 13
Full-timeColumbia, SC, USANo salary listed

About the Job

Requirements

  • A Bachelor's degree is required, or four years of job-related work experience, or an Associate's degree plus two years of job-related work experience.
  • At least one year of quality assurance experience is required.
  • Demonstrated leadership skills are required.
  • Strong analytical, presentation, customer service, persuasion, and organization skills are required.
  • Advanced business math proficiency is required.
  • The ability to document problems and assist in their resolution is required.
  • The ability to document processes and identify areas for improvement is required.
  • Strong written and verbal communication skills are required.
  • The ability to produce written documentation and summarize it for management is required.
  • Proficiency with Microsoft Office is required.

Responsibilities

  • Assign, monitor, and audit quality audit staff work, including monitoring workloads, generating work samples, analyzing outputs for timeliness and quality, and ensuring audit, performance, and reporting deadlines are met.
  • Serve as the subject matter expert and primary coordination point for the assigned work specialty, represent quality assurance on workgroups and special teams, and assume managerial tasks as needed as a backup.
  • Develop work plans, objectives, priorities, methods, and procedures to improve quality performance.
  • Write, update, and maintain work instructions; create reporting methodologies to measure the effectiveness of improvements; and use data to identify and implement qualitative and quantitative improvements focused on prevention, planning, and quality control.
  • Provide training for quality audit staff.
  • Conduct targeted quality audits for designated areas, including complex audits; enter quality results and data into databases; present audit findings to customers; negotiate errors and handle rebuttals; and complete monthly customer quality reports and trend analyses.
  • Maintain ongoing communication with departments and their management, including task forces implementing process improvements, and participate in calibration sessions, meetings, conference calls, and training.
  • Support the quality management system by gathering, synthesizing, and presenting information to division management to assess the feasibility of proposed changes.

Desired Qualifications

  • Leadership experience is preferred.
  • Familiarity with MMIS and ARMS PRO is preferred.

About the Company

BlueCross BlueShield of South Carolina

Health insurance and plan administration

BlueCross BlueShield of South Carolina is a South Carolina-owned mutual health insurer and health-plan administrator. It offers individual, employer, Medicare and other coverage while operating provider networks, member services, claims and administrative programs. The organization also supports government and commercial health contracts through related businesses and specialized operations. This profile refers specifically to the South Carolina company, not the national Blue Cross Blue Shield Association, and centers on its role connecting members, employers, healthcare providers and public programs.

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