BlueCross BlueShield of South Carolina Benefits Overview

Conducts quality audits across claims, membership, customer service, workflow, and processing operations. Analyzes errors, identifies root causes, recommends process and training improvements, monitors corrective actions, generates quality reports, supports system testing and change initiatives, and develops procedures and training materials. The role is fully onsite in Florence, South Carolina, and requires eligibility to obtain a security clearance.

Analyzes policies, procedures, workflows, reports, and performance metrics to identify operational improvements. Supports system and process implementation, testing, documentation, audits, reporting, database maintenance, quality checks, trend analysis, and employee training. Collaborates with management and internal or external groups, provides project updates, and recommends standardization, simplification, and process changes.

Process and research healthcare claims accurately and timely: verify procedure and diagnosis coding, resolve system edits and claims errors, coordinate with internal departments to update patient, provider, and insurance files per guidelines.