Analyst, Pharmacy Claims Quality Assurance
hace 6 meses
What you’ll do
In a few words…
Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning.
At Abarca, our Quality Assurance Analysts are at the forefront of pharmacy claims testing and adjudication verification by collaborating with their team within the Quality Oversight Department to maximize quality controls, diminish defects and ensure effective deployment of functionalities. This is achieved via thorough pharmacy claims testing and monitoring activities that cover areas such as new client implementations, current client changes, updates to functional requirements.
You’ll be tasked with not only understanding the connections between business requirements and technical specifications but also developing, crafting, and executing test scenarios, cases and scripts. Collaboration is key here as you’ll partner with other functional areas to ensure both the quality and integrity of all these testing and monitoring efforts We’ll also rely on you for recommendations on corrective action, process and system improvements contextualized in a deep knowledge of both the technical and operational sides of the business.
The fundamentals for the job…
Optimize testing and monitoring activities to ensure the quality of the systems and processes supporting the company’s operation. Be willing to become a SME on all lines of business (Medicare, Medicaid and stay current with regulatory guidelines) through the course of your work. Previous experience with any of these is a plus. Develop, document, and execute test plans, and test cases and/or scripts based on functional requirements. Analyze, document, and report on test results to business stakeholders and company leads. Document and track issues identified during testing activities to ensure defect resolution and testing completion. You’ll also be performing User Acceptance Testing and sign-off on new benefit functionality prior to production release. Assist in gathering proper and accurate documentation and data during internal and external audits related to the Company’s PBM processes. Log all required Quality Assurance validation processes to comply with regulatory and audit controls. Contribute to the business requirement gathering process by identifying missing requirements based on test-cases development and testing experience Collaborate in the development of new ideas and requirements to resolve testing and system’s issues, and improve current systems based on testing results. Collaborate with the development and improvement of testing strategies, techniques, procedures, and tools. Participate on projects and new client implementations to gather understanding on new system functionalities and requirements that will require testing and/or monitoring. Understand and document system logics and/or processes. Create and conduct training on system logics and/or processes. Team up to support users during issue-solving activities, new business requirements gathering, and day-to-day system operation. Collaborate interdepartmentally with key areas within the organization. Perform additional tasks or special projects as assignedWhat you’re made of
The bold requirements…
Bachelor’s degree in Business, Engineering, Healthcare or related field. Advanced education, a plus but not required. (In lieu of a degree, equivalent relevant work experience may be considered.) 2+ years of experience in a health plan, PBM setting is required. 2+ years of related experience with software development life cycles (SDLC) and quality assurance (QA) is preferred. Knowledge of any or all of the following is a big plus: Quality assurance practices and tools, Healthcare, Pharmacy, and Pharmacy Benefit Management industries, Pharmacy Benefit operational standards and processes, Medicare Part D, and Center for Medicare and Medicare Services (CMS) regulations. Ability to analyze large data sets and ability to use dashboard tools (i.e. Tableau, QVW and Excel tools) Ability to spot patterns, trends, and discrepancies in datasets through problem solving. Adapt to a challenging and fast-paced environment through strong analysis and critical thinking skills in order to maintain accountability and develop innovations through teamwork. Training and experience in testing methodologies preferred, with good troubleshooting skills, and the ability to identify and manage incidents through root cause analysis. Must have strong communication skills both oral and written.That something extra we´d love to see…
Action for Bias Solution SeekerPhysical requirements…
Must be able to access and navigate each department at the organization’s facilities. Sedentary work that primarily involves sitting/standing.-
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