Quality Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Adhere to QA testing protocols to execute standard testing scenarios and report findings for various tasks as assigned.

• Implementation of benefits for new clients.

• Modifications to benefits for existing clients.

• Conduct audits on existing client benefits.

• Execute the following standard testing scenarios:

• Comparison of documentation.

• Comparison of structure setup.

• Review automated Benefits test case outputs.

• Analyze Integrated Accumulation sharing.

• Manually enter and review test cases, applying critical thinking to assess the accuracy of test outcomes.

• Utilize critical thinking when analyzing test data results and liaise internally regarding complex issues (e.g., multiple inaccuracies, unclear criteria, or missing information) to ensure the accuracy of test results.

• Employ Microsoft Excel for structure comparisons.

• Utilize Microsoft Access to create test case specifics for automated testing.

• Familiarize yourself with all PBM documentation, software, and reporting systems relevant to our contracted PBMs.

• Thoroughly document detailed test results, including the location of identified issues, necessary screenshots, and member examples.

• Establish the appropriate testing plan based on the nature of benefit changes.

• Update or review process documentation as required.

• Provide mentorship to new or contract staff as needed.

• Maintain effective internal communication, including collaboration across departments to explain and resolve testing failures.

• Identify and escalate process inefficiencies and delays to management.

• Recognize and support opportunities for process improvements.

• Assist in the implementation of new processes and technology solutions, including user design development and user acceptance testing as assigned.

• Be available for off-hours priority work as necessary, including some holidays.

• Navigate Salesforce and/or proprietary software effectively.

• Oversee daily tasks using Clarizen project management software.

• Embrace and advocate for change positively.

• Take on additional responsibilities as assigned or directed.

⛳️ Requirements

• Minimum of 2 years of experience managing pharmacy claims.

• Proficient in MS Office, including Word, Excel, and Outlook.

• Ability to manage multiple competing priorities with minimal guidance from leadership.

• Previous experience utilizing professional written and verbal communication skills, organizational abilities, and relationship management skills.

• Strong analytical and critical thinking capabilities.

• Pharmacy Technician certification is highly preferred.

• Previous experience in data validation or implementation support is preferred.

• Experience with Pharmacy Benefit Manager (PBM) or Retail Pharmacy is preferred.

• Intermediate Excel skills and familiarity with Microsoft Access are advantageous.

• Experience with Salesforce or Clarizen is a plus.

🏝️ Benefits

• Remote-first work environment.

• Choice between a High Deductible Health Plan (HDHP) or a Preferred Provider Organization (PPO) Medical plan; we cover 100% of the premium for the HDHP for you and your eligible family members.

• Comprehensive Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance, with 100% of premiums covered for you and your family (Dental and Vision included).

• Additional buy-up options for Short- and Long-Term Disability and Life Insurance.

• 401(k) plan with an employer match up to 3.5%, available after 60 days of employment.

• Community Service Day to support causes you are passionate about in your community.

• 10 company holidays, including Martin Luther King Jr. Day, Juneteenth, and the day after Thanksgiving, plus one floating holiday for personal use.

• Reimbursement for high-speed internet; we will provide a computer and monitors to help you perform at your best.

• Tuition Reimbursement for accredited degree programs.

• Paid New Parent Leave, applicable for adoption or birth.

• Pet insurance to safeguard your furry companions.

• Comprehensive mental health benefits and Employee Assistance Program (EAP) services through Spring Health to support you during challenging times.