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Pharmacy Claims Quality Assurance Specialist
hace 1 mes
We are seeking a highly skilled Quality Assurance Analyst to join our team at Abarca Health. As a Quality Assurance Analyst, 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.
- Document and track issues identified during testing activities to ensure defect resolution and testing completion.
- Perform 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 our 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.
- Bachelor's degree in Business, Engineering, Healthcare or related field. Advanced education, a plus but not required.
- 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.
- Action for Bias
- Solution Seeker
- Must be able to access and navigate each department at the organization's facilities.
- Sedentary work that primarily involves sitting/standing.
