QA Analyst PBM Implementation @ Talentify.io
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About the QA Analyst PBM Implementation Role
This position offers an opportunity to advance your career in quality assurance within Pharmacy Benefit Management. Work remotely from anywhere in the continental U.S. while making a positive impact on quality assurance processes and client satisfaction.
Job Responsibilities
- Perform complex quality reviews and address escalated QA issues.
- Conduct inter-rater reliability exercises and provide performance feedback.
- Analyze cases to prevent errors based on compliance and regulatory guidance.
- Collaborate with trainers and writers to enhance training modules.
- Assist in gathering and documenting requirements for system enhancements.
Qualifications
Bachelor's degree in Business, Liberal Arts or related field; HS diploma or GED required. Minimum 2 years of experience in Claims Processing, Audit, Quality or Pharmacy. U.S. work eligibility required without visa/residency sponsorship. Additional experience or certification in Clinical Review or Pharmacy is a plus.
Preferred Qualifications
National Pharmacy Technician Certification (PTCB, ExCPT/CPhT) or Licensed Practical Nurse certification; Experience in Medicare, healthcare audit, or metric reporting; Familiarity with RxClaim and benefit design/review processes; Background in PBM or healthcare settings.
Key skills/competency
- Quality Assurance
- Pharmacy Benefit Management
- Compliance
- Inter-rater Reliability
- Training Collaboration
- Documentation
- Analytical Skills
- Claims Processing
- Healthcare
- Audit
How to Get Hired at Talentify.io
🎯 Tips for Getting Hired
- Customize your resume: Highlight relevant QA and PBM experience.
- Research Talentify.io: Understand their culture and mission.
- Showcase certifications: Emphasize Pharmacy Technician or related certifications.
- Prepare examples: Demonstrate past quality and audit successes.