Pharmacy Claims Quality Assurance Specialist

hace 2 semanas


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

About the Role

Abarca Health is seeking a 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.
  • 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.

Requirements

  • Bachelor's degree in Business, Engineering, Healthcare, or related field.
  • 2+ years of experience in a health plan, PBM setting.
  • Knowledge of quality assurance practices and tools, healthcare, pharmacy, and pharmacy benefit management industries.
  • Ability to analyze large data sets and use dashboard tools.

What We Offer

  • A dynamic and fast-paced work environment.
  • Opportunities for professional growth and development.
  • A competitive salary and benefits package.


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