QA Analyst PBM Implementation - Remote

Prime Therapeutics; Home (PA); Remote; USD 79,000 - 94,000; Full time

Job summary

A pharmacy benefit management company is seeking a Quality Assurance Specialist to perform complex reviews and enhance client satisfaction. Candidates should possess a bachelor's degree and at least 2 years of experience in relevant fields. The position offers a salary of up to $94,000 and the opportunity to work remotely from anywhere in the U.S.

Benefits

Opportunity for career advancement

Supportive work environment

Qualifications

• Minimum of 2 years of experience in Claims Processing, Audit, Quality, or Pharmacy.
• Must be eligible to work in the United States without the need for visa sponsorship.
• Strong organizational, analytical, and communication skills.

Responsibilities

• Perform complex quality reviews as a subject matter expert for escalated QA issues.
• Conduct ongoing inter-rater reliability exercises and provide performance feedback.
• Analyze cases to prevent errors based on compliance and regulations.

Skills

Organizational skills

Analytical skills

Communication skills

Education

Bachelor's degree in Business, Liberal Arts or related area

HS diploma or GED

Tools

RxClaim

Job description

Overview

Employer Industry: Pharmacy Benefit Management

Why consider this job opportunity

• Salary up to $94,000.00 based on experience and skills
• Opportunity for career advancement and growth within the organization
• Work remotely from anywhere within the continental U.S.
• Supportive and collaborative work environment
• Chance to make a positive impact on quality assurance processes and client satisfaction

Responsibilities

• Perform complex quality reviews and serve as a subject matter expert for escalated QA issues
• Conduct ongoing inter-rater reliability exercises and provide performance feedback for less tenured staff
• Analyze cases to prevent errors based on compliance, service level agreements, and regulatory guidance
• Collaborate with trainers and writers to enhance training modules and documentation
• Assist in gathering and documenting requirements for new system enhancements

Qualifications

• Bachelor's degree in Business, Liberal Arts, or a related area of study, or equivalent combination of education and/or experience; HS diploma or GED is required
• Minimum of 2 years of experience in Claims Processing, Audit, Quality, or Pharmacy
• Must be eligible to work in the United States without the need for work visa or residency sponsorship
• If applicable, 1 year of experience as a Clinical Review Technician or 2 years in Clinical Review; or National Pharmacy Technician Certification and 2 years working in a pharmacy
• Strong organizational, analytical, and communication skills

Preferred Qualifications

• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) or Licensed Practical Nurse certification if working in Medicare
• Experience in a healthcare, audit, or reporting metrics environment
• Familiarity with RxClaim
• Experience in benefit design and review processes for multiple clients
• Background in PBM or healthcare settings

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