Pharmacy Claims Quality Assurance Specialist

hace 2 días


San Juan, San Juan, Puerto Rico abarca health A tiempo completo
Job Summary

Abarca Health is seeking a highly skilled Pharmacy Claims Quality Assurance Specialist to join our team. As a key member of our Quality Oversight Department, you will play a critical role in ensuring the quality and integrity of our pharmacy claims testing and adjudication processes.

Key Responsibilities
  • Optimize testing and monitoring activities to ensure the quality of our systems and processes.
  • 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.
  • 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.
Requirements
  • Bachelor's degree in Business, Engineering, Healthcare, or related field.
  • 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 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.
What We Offer
  • A dynamic and fast-paced work environment.
  • Opportunities for professional growth and development.
  • A competitive salary and benefits package.
How to Apply

If you are a motivated and detail-oriented individual with a passion for quality assurance, please submit your application, including your resume and cover letter, to [insert contact information].



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