Quality Assurance Manager

hace 2 semanas


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

About the Role

Abarca Health is seeking a highly skilled Quality Assurance Manager to lead our Quality Assurance team. As a key member of our PBM Operations & Services team, you will be responsible for developing and directing the timely performance and completion of all quality assurance activities.

Key Responsibilities

  • Monitor overall performance and manage the development, coordination, and administration of the Quality Assurance team.
  • 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.

Requirements

  • Bachelor's Degree in Business, Engineering, Healthcare, or related field.
  • 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.

Physical 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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