Supervising staff in conducting quality control audits at BlueCross BlueShield in Columbia. Involves mediating staff conflicts, setting standards, and training.
Responsibilities
Supervises staff in conducting timely quality control audits for one or more functions; claims, customer service inquiries, membership, coordination of benefits, refunds, billing, etc.
May also supervise staff in completing special projects including system changes.
Mediates and negotiates staff conflicts, makes hiring, disciplinary and performance decisions and sets department goals or standards.
Determines training priorities and coordinates internal training activities as needed.
Identifies and recommends procedural enhancements to improve quality and minimize financial loss to the corporation.
Prepares and reviews reports and analyses providing interpretation of production and quality standards.
Maintains and updates desk procedures to ensure quality and minimize processing errors.
Requirements
Required Education: Bachelor's degree.
Degree Equivalency: 4-years job related work experience OR Associate's and 2-years job related work experience
Required Work Experience: 3-years of experience performing quality audits, including 1-year of related claims processing, customer service, auditing, training, analysis or operations experience.
Required Skills and Abilities: Conducts audits
Prepares summary reports
Demonstrates strong proficiency in math
Maintains quality improvement process
Writes reports of audit findings
Benefits
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
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