Quality Assurance Analyst
Job Posting Summary:
We are looking for an experienced QA Analyst with 4-7 years of experience for a fully remote position. The ideal candidate must possess good analytical and critical thinking skills. Experience in Pharmacy Benefit Management (PBM) and claims is required.This role offers a negotiable salary based on qualifications. If you meet these criteria and are interested in the position, please send your resume to jenni.josten@randstadusa.com for review and potential phone screening.
salary: $45 - $55 per hourshift: First
work hours: 8 AM - 4 PM
education: Associate
Responsibilities
Responsible for providing quality assurance for internal processes and suggesting additional additions, whenappropriate.
Understands and defines the performance and quality standards expected of Claims Processing employees.
Evaluates quality standards from an objective point of view and ensures the proper checks and balances are
applied to all parts of the Claims Processing procedures.
Responsible for being fully trained in both the claims processor and other internal programs so an adequateknowledge base can be used when evaluating and following procedures.
Participate in the design of procedures of but not limited to reimbursement audits, group/plan design, in-
house ticket, group/plan changes, SOC audits, and QA testing in internal program(s).
Report findings and follow through with resolution resulting from claims analysis. Document results and follow through resolution within departments tracking system.
Participate in a culture of continuous improvement, open door policy and internal support system.
Abide by all obligations under HIPAA related to Protected Health Information (PHI).
2 years of PBM experience in a Quality Analysis and Controls setting OR 3 years of PBM experience in Benefit Design execution or Implementation at a high level
Skills- Claims
- Analytical Thinking
- critical thinking
- QA
- PBM
- SQL
- Managing tickets
- HIPAA
- Years of experience: 4 years
- Experience level: Experienced
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At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.