Quality Assurance Specialist – Benefits & Formulary Testing

ProCare Pharmacy Benefit Manager, Inc.; Gainesville (GA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health benefits

Paid vacation

Wellness program

401(k) with match

Employee assistance program

Referral program

Job summary

ProCare Rx is seeking a Quality Assurance Business Specialist to audit new plan/group implementations and test modifications to existing plans. The role involves generating reports, validating plan setups, and coordinating with multiple departments to ensure accuracy and timely updates.

The ideal candidate will be a certified Pharmacy Technician with experience in quality control, process testing, and precise documentation.

Qualifications

• Audit new plan/group implementations for accuracy and completeness.
• Test modifications to existing plans/groups and document results.
• Prepare reports to validate plan setups and ensure billing reversals.
• Communicate findings across departments to implement changes.
• Proofread and review materials for consistency and clarity.

Responsibilities

• Execute QAB-related tasks and processes in the QAB department.
• Run weekly reports to validate plan flags are set appropriately.
• Run billing reports to validate test claims reversed before billing cycle.
• Write reports producing accurate information to validate plan setups.
• Review materials to ensure client requests are satisfied and updates are correct.
• Document testing procedures for new functionality and present insights.

Skills

Quality Control

Test reporting

System testing

Proactive communication

Excel

Google Sheets

Documentation

Education

Certified Pharmacy Technician

Tools

R&R Reports Works

Job description

ProCare Rx is seeking a Quality Assurance Business Specialist to audit new plan/group implementations and test modifications to existing plans. The role involves generating reports, validating plan setups, and coordinating with multiple departments to ensure accuracy and timely updates.

The ideal candidate will be a certified Pharmacy Technician with experience in quality control, process testing, and precise documentation.