Manager, Quality Assurance
hace 6 meses
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…
Providing high quality services to client and beneficiaries is at the core of what we do every day The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations and beneficiary services to government services and beyond. Within this division, our Quality Assurance & Oversight team leads the charge in quality oversight, root cause analysis, findings and corrective actions regarding adjudications and pharmacy claims.
As a Manager, Quality Assurance you will lead the Quality Assurance team and would be responsible to develop and direct the timely performance and completion of all our quality assurance activities. You will also be responsible to lead recurring and impromptu quality assurance tests and monitoring activities as part of projects, new client implementations, current client change, and/or new functional requirements implementations, ensuring the quality of the systems and processes that support the company’s operation. You will identify and provide feedback on potential operational issues, analyzing and identifying solutions to resolve claims processing issues and other operational gaps and mishaps. We count on you to help point out process improvement opportunities to make the configuration of benefit plan designs more efficient.
What you’ll do
In a few words…
You will monitor overall performance and manage the development, coordination and administration of the Quality Assurance team, including setting, reviewing and measuring quality standards, documentation standards, processes and procedures, performance reviews, quarterly/semiannual check-ins and staff meetings to guide performance management and employee development efforts and direct them toward departmental goals, including quality and process improvement efforts. Develop, track and report key quality metrics to monitor and report on testing and quality efforts and results to business stakeholders and company leads. Develop, supervise and perform quality assurance of benefit set-up, network, pricing and formulary configurations. Lead the preparation and implementation of quality assurance activities such as testing, policies, procedures, workflows and training. Contribute to the business requirement gathering process by identifying missing requirements based on test cases development and testing experience. Assist in gathering proper and accurate documentation and data during internal and external audits related to the Company’s PBM processes. Stay up to date on external regulator guidelines (such as Medicare, Medicaid and state requirements) in order to assess that adjustments made to operational processes are in compliance with rules and regulations.What you’re made of
The bold requirements…
Bachelor Degree in Business, Engineering, Healthcare or related field. (In lieu of a degree, equivalent, relevant work experience may be considered.) 5+ years of experience in benefits configuration and testing within a non-retail pharmacy setting. 3+ years of experience managing a team Strong understanding of PBM Operations, Member Services, Pharmacy Networks; Fulfillment, Call Center, and Medicare. Experience with dashboard tools (e.g., Tableau, Structured Query Language and Excel tools) Strong presentation skills, attention to detail and customer-service focus. Computer proficiency in Microsoft Office products. Occasional travel, up to 10% during a year. Excellent oral and written communication skills.Nice to have…
Fluency in Spanish is a plus. Training and experience in testing methodologies. Programming knowledge.That something extra we´d love to see…
Analytical Innovator Solution Seeker StrategicPhysical 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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