BlueCross BlueShield of South Carolina Benefits Overview

Coordinate and conduct internal ISO 9001:2015 audits, track and report corrective/preventive actions, maintain document control, support external audits, provide training, and analyze quality data to drive process improvements.

Provide telephonic and remote case management for maternity/NICU and other high-risk patients: assess needs, develop and coordinate care plans, authorize services, document clinical decisions, educate members and providers, promote program enrollment, and ensure compliance with regulatory and contract guidelines.

Extract and report enrollment and financial data to develop competitive rates and meet profitability goals. Build actuarial models and reporting for new products, maintain rating system tables and documentation, produce monthly and ad hoc reports, support underwriting and actuarial staff, document regulatory submissions, and perform profitability analysis across lines of business.