Job Details
Quality Analyst
The Quality Analyst is responsible for quality assurance of new implementations, existing client benefit changes, and continuous process improvement. The Quality Analyst ensures every phase and feature of the client solution is audited and tested and that any potential issue is identified and fixed before the product goes live or as soon as allowed by external systems. This role requires knowledge of our contracted PBM's internal systems, as well as RxB internal systems. This person will exude excellent communication skills, independent work management, and the ability to identify and resolve complex issues analytically. This individual will need to follow process documentation to ensure accuracy, but also utilize critical thinking if some items are not readily provided during auditing. This individual's activities must facilitate continuous improvement and a dedication to excellence in a climate of fast growth and demanding responsibilities.
_Essential Job Responsibilities Include:_
+ Follow QA testing procedures to complete standard testing scenarios and reporting for the following and additional testing as assigned.
+ New client benefit implementations
+ Existing client benefit changes
+ Existing client benefit audits
+ Complete the following standard testing scenarios:
+ Documentation comparison
+ Structure set-up comparison
+ Review of automated Benefits test case output
+ Review of Integrated Accumulation sharing
+ Manual test case entry and review, using critical thinking to determine accuracy of test results
+ Use critical thinking skills in reviewing test data results, reaching out internally around complex situations (such as multiple inaccuracies, poorly defined criteria or missing details, escalations) to ensure the most accurate test results are provided.
+ Use Microsoft Excel to complete structure comparisons.
+ Use Microsoft Access to create test case details to apply for automated testing.
+ Learn all PBM documentation, software, and reporting systems for our contracted PBMs
+ Accurately document detailed test results; including location of issues found, screen shots and member examples as necessary.
+ Determine appropriate test plan based on the type of benefit changes.
+ Update or review process documentation, as assigned.
+ Assist with mentoring new or contract staff, as assigned.
+ Effective internal communication, including cross-department collaboration to explain and resolve testing failures
+ Identify and escalate process deficiencies and delays to supervision.
+ Identify and support process improvement opportunities.
+ Support new process and technology solutions, including associated user design development and user acceptance testing, as assigned.
+ Supports off-hours priority work as needed, including some holidays.
+ Effectively navigate Salesforce and/or proprietary software.
+ Manage day-to-day work in Clarizen project management software.
+ Positively accepts and promotes change.
+ Assumes additional responsibilities as prescribed or directed.
_Required Skills / Experience:_
+ 2+ years of experience handling pharmacy claims
+ Proficient in MS Office (Including Word, Excel, Outlook)
+ Ability to handle multiple and competing priorities with little direction from leadership
+ Prior work experience leveraging professional written and oral communication skills; organization skills; and relationship management skills
+ Possess analytical and critical thinking skills
_Preferred Skills/Experience:_
+ Pharmacy Tech strongly preferred
+ Prior data validation or implementation support experience preferred
+ Pharmacy Benefit Manager (PBM) or Retail Pharmacy experience preferred
+ Intermediate Excel skills and familiarity with Microsoft Access is a plus
+ Salesforce or Clarizen experience is a plus
_Based on relevant market data and other factors, the anticipated hiring range for this role is $23.00 to $27.02_ _per hour. Final compensation rates will be determined based on various factors, including but not limited to experience, skills, knowledge, and internal equity considerations. This role is also short-term incentive eligible. Incentive amounts will vary by individual and business goals._
_We are committed to fair and equitable compensation practices. The final salary offered to the selected candidate may vary from the posted range due to individual qualifications. Our goal is to ensure that all teammates are compensated fairly and competitively based on their contributions to our organization._
_RxBenefits is also committed to providing best in class benefits to our teammates. We offer a robust total rewards package that includes:_
+ _Remote first work environment_
+ _Choice of a HDHP or PPO Medical plan, we pay 100% of the premium for the HDHP for you and your eligible family members_
+ _Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance that we also pay 100% of premiums (for your family too on Dental and Vision)_
+ _Additional buy-up options for Short- and Long-Term Disability and Life Insurance_
+ _401(k) with an employer match up to 3.5% available after 60 days_
+ _Community Service Day to give back and support what you love in your community_
+ _10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving plus a floating holiday to use as you like_
+ _Reimbursements for high-speed internet, we'll send you a computer and monitors to help you do your best work_
+ _Tuition Reimbursement for accredited degree programs_
+ _Paid New Parent Leave that can be used for adoption or birth_
+ _Pet insurance to protect your furbabies_
+ _A robust mental health benefit and EAP service through Spring Health to support you when you need it most_
RxBenefits provides equal opportunities for everyone who works for us and everyone who applies to join our team, without regard to sex or gender, gender identity, gender expression, age, race, religious creed, color, national origin, ancestry, pregnancy, physical or mental disability, medical condition, genetic information, marital status, sexual orientation, any service, past, present, or future, in the uniformed services of the United States (military or veteran status), or any other consideration protected by federal, state, or local law.
_Essential Job Responsibilities Include:_
+ Follow QA testing procedures to complete standard testing scenarios and reporting for the following and additional testing as assigned.
+ New client benefit implementations
+ Existing client benefit changes
+ Existing client benefit audits
+ Complete the following standard testing scenarios:
+ Documentation comparison
+ Structure set-up comparison
+ Review of automated Benefits test case output
+ Review of Integrated Accumulation sharing
+ Manual test case entry and review, using critical thinking to determine accuracy of test results
+ Use critical thinking skills in reviewing test data results, reaching out internally around complex situations (such as multiple inaccuracies, poorly defined criteria or missing details, escalations) to ensure the most accurate test results are provided.
+ Use Microsoft Excel to complete structure comparisons.
+ Use Microsoft Access to create test case details to apply for automated testing.
+ Learn all PBM documentation, software, and reporting systems for our contracted PBMs
+ Accurately document detailed test results; including location of issues found, screen shots and member examples as necessary.
+ Determine appropriate test plan based on the type of benefit changes.
+ Update or review process documentation, as assigned.
+ Assist with mentoring new or contract staff, as assigned.
+ Effective internal communication, including cross-department collaboration to explain and resolve testing failures
+ Identify and escalate process deficiencies and delays to supervision.
+ Identify and support process improvement opportunities.
+ Support new process and technology solutions, including associated user design development and user acceptance testing, as assigned.
+ Supports off-hours priority work as needed, including some holidays.
+ Effectively navigate Salesforce and/or proprietary software.
+ Manage day-to-day work in Clarizen project management software.
+ Positively accepts and promotes change.
+ Assumes additional responsibilities as prescribed or directed.
_Required Skills / Experience:_
+ 2+ years of experience handling pharmacy claims
+ Proficient in MS Office (Including Word, Excel, Outlook)
+ Ability to handle multiple and competing priorities with little direction from leadership
+ Prior work experience leveraging professional written and oral communication skills; organization skills; and relationship management skills
+ Possess analytical and critical thinking skills
_Preferred Skills/Experience:_
+ Pharmacy Tech strongly preferred
+ Prior data validation or implementation support experience preferred
+ Pharmacy Benefit Manager (PBM) or Retail Pharmacy experience preferred
+ Intermediate Excel skills and familiarity with Microsoft Access is a plus
+ Salesforce or Clarizen experience is a plus
_Based on relevant market data and other factors, the anticipated hiring range for this role is $23.00 to $27.02_ _per hour. Final compensation rates will be determined based on various factors, including but not limited to experience, skills, knowledge, and internal equity considerations. This role is also short-term incentive eligible. Incentive amounts will vary by individual and business goals._
_We are committed to fair and equitable compensation practices. The final salary offered to the selected candidate may vary from the posted range due to individual qualifications. Our goal is to ensure that all teammates are compensated fairly and competitively based on their contributions to our organization._
_RxBenefits is also committed to providing best in class benefits to our teammates. We offer a robust total rewards package that includes:_
+ _Remote first work environment_
+ _Choice of a HDHP or PPO Medical plan, we pay 100% of the premium for the HDHP for you and your eligible family members_
+ _Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance that we also pay 100% of premiums (for your family too on Dental and Vision)_
+ _Additional buy-up options for Short- and Long-Term Disability and Life Insurance_
+ _401(k) with an employer match up to 3.5% available after 60 days_
+ _Community Service Day to give back and support what you love in your community_
+ _10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving plus a floating holiday to use as you like_
+ _Reimbursements for high-speed internet, we'll send you a computer and monitors to help you do your best work_
+ _Tuition Reimbursement for accredited degree programs_
+ _Paid New Parent Leave that can be used for adoption or birth_
+ _Pet insurance to protect your furbabies_
+ _A robust mental health benefit and EAP service through Spring Health to support you when you need it most_
RxBenefits provides equal opportunities for everyone who works for us and everyone who applies to join our team, without regard to sex or gender, gender identity, gender expression, age, race, religious creed, color, national origin, ancestry, pregnancy, physical or mental disability, medical condition, genetic information, marital status, sexual orientation, any service, past, present, or future, in the uniformed services of the United States (military or veteran status), or any other consideration protected by federal, state, or local law.
Job #NLX293641018