Testing and Quality Control Analyst at EnvisionRxOptions
Testing & Quality Control Analyst
Job ID: 84110-50-209-001
Other QSA TESTI02088
- REMOTE Anywhere in the USA
The Testing and Quality Control Analyst is responsible for performing benefit design soundness through various internal methods to ensure systems are set up and maintained appropriately, allowing accurate claim adjudication. This position has no direct reports.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Review and understand client specifications and benefit design builds through RxPlan and PharmScreens software platforms
- Build/Run standard and custom batch claim files for clients in all lines of business and benefit design complexities
- Analyze and interpret test claims for processing and adjudication results to ensure configuration accuracy and compliance
- Perform benefit compare analysis between PharmScreens and RxPlan
- Conduct automated claims testing through RxPlan, analyzing results
- Serve as point of contact for other departments troubleshooting plan/benefit configuration related questions through claims testing
- Report findings and follow through with resolution resulting from all analytical work, including but not limited to batch testing, benefit compares, automated claims testing, and applicable inquiries
- Field questions from various levels of management pertaining to testing results
- Document results and follow through resolution within department’s tracking system
- Other duties as assigned
- Bachelor’s degree in health administration, business or related field; proven industry experience may be acceptable in lieu of degree
- Demonstrated ability to manage multiple priorities and deadlines
- Ability to independently identify, research, analyze, and resolve issues with minimal supervision
- Oral and written communication skills with a high degree of professionalism
- Ability to work with peers in a team effort
- Time management and organizational skills being able to handle multiple priorities in a fast-paced environment
- Ability to work extended hours, weekends, and holidays pursuant with industry demands
- Proficient in Microsoft Office and industry related software programs
- Medicare Part D knowledge
- Minimum 3 years of pharmacy claim analysis experience and/or PBM experience
Includes a typical office environment, with minimal exposure to excessive noise or adverse environmental issues.
Ability to sit for prolonged periods of time.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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