Pharmacy Benefit QA Specialist

Job Description

Job Description

The Pharmacy Benefit QA Specialist is responsible for auditing new plan / group implementation setups to ensure all plan parameters are accurately in the system. This person is also responsible for testing any modifications to existing plans / groups.

ESSENTIAL DUTIES AND RESPONSIBILITIES Included but not limited to the following :

• Execute QA-related tasks and processes in the QA department.
• Run weekly reports to validate plan flags are set appropriately.
• Run billing reports to validate that all test claims have been reversed after the billing cycle commences.
• Write reports that will produce accurate information needed to validate that plan setups are accurate.
• Review all material at hand to determine if plan changes match requests from the client.
• Work with various departments as needed to have plans updated to satisfy requested changes.
• Document with test claims and reports the items that were tested and approved.
• Write up testing procedures for new functionality.
• Make presentations to your peers as a department learning tool.
• Miscellaneous duties as requested

QUALIFICATIONS AND REQUIREMENTS

PHYSICAL DEMANDS

ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at (678) 248-4755 or email us at HR@procarerx.com.

ProCare Rx is an Equal Opportunity Employer.