Prime Therapeutics
QA Analyst PBM Implementation - Remote
NewJob Description
- Req#: R-15532
Employer Industry: Pharmacy Benefit Management
Why consider this job opportunity:
- Salary up to $94,000.00 based on experience and skills
- Opportunity for career advancement and growth within the organization
- Work remotely from anywhere within the continental U.S.
- Supportive and collaborative work environment
- Chance to make a positive impact on quality assurance processes and client satisfaction
What to Expect (Job Responsibilities):
- Perform complex quality reviews and serve as a subject matter expert for escalated QA issues
- Conduct ongoing inter-rater reliability exercises and provide performance feedback for less tenured staff
- Analyze cases to prevent errors based on compliance, service level agreements, and regulatory guidance
- Collaborate with trainers and writers to enhance training modules and documentation
- Assist in gathering and documenting requirements for new system enhancements
What is Required (Qualifications):
- Bachelor's degree in Business, Liberal Arts, or a related area of study, or equivalent combination of education and/or experience; HS diploma or GED is required
- Minimum of 2 years of experience in Claims Processing, Audit, Quality, or Pharmacy
- Must be eligible to work in the United States without the need for work visa or residency sponsorship
- If applicable, 1 year of experience as a Clinical Review Technician or 2 years in Clinical Review; or National Pharmacy Technician Certification and 2 years working in a pharmacy
- Strong organizational, analytical, and communication skills
How to Stand Out (Preferred Qualifications):
- National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) or Licensed Practical Nurse certification if working in Medicare
- Experience in a healthcare, audit, or reporting metrics environment
- Familiarity with RxClaim
- Experience in benefit design and review processes for multiple clients
- Background in PBM or healthcare settings
#PharmacyBenefitManagement #QualityAssurance #RemoteWork #CareerGrowth #HealthcareExperience
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
We build relationships. It’s how we make medicine more affordable, help our members be healthier and keep costs down.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,...
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