Business Operations Specialist

Bluecross Blueshield of South Carolina - Myrtle Beach, SC

Full-time - Mid Level

Myrtle Beach, SC

Insurance Carriers and Related Activities

About the position

The Senior Quality Assurance Analyst plays a crucial role in ensuring the accuracy and effectiveness of various departmental operations functions. This includes conducting quality control audits across areas such as claims processing, membership management, benefit files, customer service, and workflow processing support systems. The analyst is responsible for identifying problems, analyzing their causes, and making recommendations for improvements to enhance operational efficiency and quality standards. In this full-time position, the analyst will work onsite in Myrtle Beach, South Carolina, and will be expected to conduct focused quality audits to ensure compliance with established procedures and methodologies. The role involves documenting findings from these audits and preparing actionable recommendations for the implementation of new systems, procedures, or organizational changes aimed at reducing errors. The analyst will also identify weaknesses in current processes and communicate necessary changes to training materials, providing feedback to management on detected errors and ensuring that they are resolved effectively. Additionally, the Senior Quality Assurance Analyst will develop and implement a quality control and improvement program based on targets identified through quality reviews. This includes monitoring and evaluating the implementation of corrective action plans, compiling data, and generating reports on quality performance for operations and training areas. The analyst will also be responsible for training new employees and staying current with guideline changes and work instructions. Writing or assisting in the creation of desk procedures and training materials for various departments is also a key responsibility. The analyst may also assist with special projects, such as testing for new business implementations or system changes, reviewing change requests, and interpreting department workload and statistical reports.

Responsibilities

• Conduct focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
• Document findings of analysis and prepare recommendations for the implementation of new systems, procedures, or organizational changes to reduce errors.
• Identify areas of weakness and communicate recommendations on changes and improvements to training materials.
• Provide feedback to management on errors detected, ensure errors are resolved, and provide long-range solutions to causes.
• Develop and implement a quality control and improvement program based on targets identified through the quality reviews.
• Monitor and evaluate the implementation of corrective action plans.
• Compile data, provide feedback, and generate reports for operations and/or training areas on quality performance.
• Train new employees and remain current with all guideline changes, work instructions, etc.
• Write or assist in writing desk procedures and training materials for departments.
• Provide assistance with special projects such as testing for new business implementation or system changes, review change requests, interpret department workload, statistical reports, assist co-workers, etc.

Requirements

• A High School Diploma or equivalent.
• 1 year of related claims processing, customer service, auditing, training, analysis or operations experience.
• 2 years of experience performing quality audits.
• Strong analytical, presentation, customer service, persuasion, and organization skills.
• Strong business math proficiency.
• The ability to document problems and assist in their resolution.
• The ability to document processes and identify areas for improvement.
• Strong written and verbal communication skills.
• Knowledge of Microsoft Office applications.

Nice-to-haves

• Strong proficiency with Excel and Access.
• Prior experience with PGBA.
• Knowledge of BlueCross systems such as CMMS.

Benefits

• 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 a healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.