Remote Quality Assurance Analyst, Participant Services

Everise, Inc.; Town of Texas (WI); On-site; USD 65,000 - 90,000; Full time

Job summary

Everise, Inc. is hiring for a Quality Analyst in a work-from-home role based in Texas. The position focuses on performing quality audits, evaluating documentation accuracy, and generating weekly and monthly reports to drive improvements.

You will identify root causes, monitor performance against SLAs, and ensure HIPAA and CMS compliance. The ideal candidate has 3+ years in PBM or healthcare operations, strong communication skills, and experience with multiple pharmacy systems.

Qualifications

• High School Diploma or GED required.
• 3+ years in PBM, specialty pharmacy, participant services, or healthcare operations.
• Previous leadership or quality experience relevant to the role.

Responsibilities

• Perform routine quality audits using approved scorecards.
• Evaluate documentation accuracy and policy adherence.
• Prepare weekly and monthly quality reports.
• Provide objective audit feedback to leaders.
• Identify root causes and recurring defect trends.
• Support coaching effectiveness through post-audit validation.
• Monitor daily performance against SLA, productivity, quality, and schedule adherence.
• Ensure HIPAA, CMS, and state board of pharmacy compliance.
• Use reporting to identify trends and recommend corrective actions.
• Partner with Workforce Management, Training, Operations, and Leadership.
• Lead or support special projects as assigned.
• Support non-clinical prescription processing and participant service workflows.

Skills

Written communication

Verbal communication

Leadership

Critical thinking

Prioritization

Pharmacy systems experience

Excel proficiency

Education

High School Diploma or GED

Tools

Microsoft Office

Pharmacy systems

Job description

Everise, Inc. is hiring for a Quality Analyst in a work-from-home role based in Texas. The position focuses on performing quality audits, evaluating documentation accuracy, and generating weekly and monthly reports to drive improvements.

You will identify root causes, monitor performance against SLAs, and ensure HIPAA and CMS compliance. The ideal candidate has 3+ years in PBM or healthcare operations, strong communication skills, and experience with multiple pharmacy systems.