Summary
Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements.
Description
Location
This role is full time M-F 8am-5pm, at our Columbia, SC location. Onsite for the first 90 days with opprotunity to go hybrid after.
What You Will Do:
Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed
Recognizes and documents any potential fraud and abuse situations. May provide one on one guidance to new hires upon completion of initial training
Provides necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed
Compiles data and generates reports for operations areas on quality performance
Identifies areas of weakness and communicates recommendations on changes and improvements to training materials
Documents findings of analysis and prepares recommendations for implementation of new systems, procedures or organizational changes
Assists with training documentation and development of new processes and procedures
Remains current with all guidelines, work instructions, etc
To Qualify for This Position, You Will Need:
Required Education: High School Diploma OR equivalent
Required Work Experience: One (1) year of related claims processing, customer service, auditing, training, analysis, or operations experience
Required Software and tools: Microsoft Office
Required Skills and Abilities: Good analytical, customer service, and organization skills. Basic business math proficiency. Able to document problems and assist in their resolution. Able to document processes and identify areas for improvement. Effective written and verbal communication skills. Strong business math proficiency. Able to document problems and assist in their resolution. Able to document processes and identify areas for improvement. Strong written and verbal communication skills
What We Prefer:
1 year-of experience in a healthcare or insurance industry.
What We Can Do for You:
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 healthy lifestyle premium discount
Tuition assistance
Service recognition
Incentive Plan
Merit Plan
Continuing education funds for additional certifications and certification renewal
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
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Skills Required
- High School Diploma OR equivalent
- One year of related work experience
- Good analytical and organization skills
- Effective written and verbal communication skills
BlueCross BlueShield of South Carolina Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about BlueCross BlueShield of South Carolina and has not been reviewed or approved by BlueCross BlueShield of South Carolina.
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Healthcare Strength — The package includes multiple medical and dental plan options, free vision, company‑paid life insurance, and short‑/long‑term disability, plus wellness programs and an EAP. On‑site clinics and fitness centers at major locations complement core health coverage.
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Leave & Time Off Breadth — Paid time off starts at about four weeks per year alongside nine paid holidays. This provides substantial baseline leave from day one.
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Wellbeing & Lifestyle Benefits — Wellness discounts, coaching, and incentives are emphasized, with on‑site fitness resources where available. Additional tools and services support day‑to‑day wellbeing.
BlueCross BlueShield of South Carolina Insights
What We Do
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now!
