Quality Assurance Sr. Manager

Description

Overview:

The Senior Manager – Quality Assurance plays a critical role in ensuring the highest standards of service and compliance within our pharmacy benefits operations. This role is responsible for designing, implementing, and continuously improving quality assurance processes that enhance client and member experiences while ensuring adherence to HIPAA and other regulatory requirements. The ideal candidate will have a strong background in quality assurance within the pharmacy benefits industry (PBM preferred) and a passion for process optimization and team development.

Key Responsibilities:

• Design and Implement QA Processes & Procedures:
  • Develop and enforce quality assurance frameworks to ensure accuracy, compliance, and efficiency in PBM operations.
  • Establish standard operating procedures (SOPs) for quality control and audits.
• Continuous Monitoring & Quality Improvement:
  • Conduct ongoing assessments of QA processes, identifying areas for enhancement.
  • Implement data-driven improvements to optimize performance and reduce errors.
  • Collaborate with internal teams to address root causes of quality issues.
• Client & Member Experience Optimization:
  • Ensure seamless service delivery while maintaining high-quality standards.
  • Drive initiatives that enhance customer satisfaction while upholding regulatory and HIPAA compliance.
  • Serve as a key escalation point for quality-related issues impacting client and member experiences.
• Develop & Train QA Talent:
  • Lead, mentor, and develop QA team members, fostering a culture of continuous improvement.
  • Design and implement training programs to ensure staff are equipped with the latest industry knowledge.
  • Monitor team performance, provide feedback, and support professional growth.

Qualifications

Qualifications:

• 5 years of quality assurance experience in the pharmaceutical benefits industry (PBM experience preferred).
• Strong knowledge of HIPAA, CMS, and other regulatory compliance standards in healthcare and pharmacy benefits.
• Proven track record in process development, continuous improvement, and quality monitoring.
• Experience in leading and developing teams, with strong coaching and mentoring skills.
• Strong analytical and problem-solving skills, with the ability to interpret complex data.
• Excellent communication and stakeholder management skills.
• Proficiency in QA tools, reporting systems, and compliance tracking software.

Salary : $115,000 - $135,000