Pharmacy Quality Assurance Specialist

About This Role

The Pharmacy Quality Assurance Specialist evaluates the quality of services and interactions within the enterprise, focusing on enrollment, billing, claims, and customer service. This role identifies issues, trends audit results, and provides feedback to management.

Responsibilities

• Evaluate the quality and accuracy of transactions and communications with providers, groups, and policyholders
• Identify, document, and report any transaction errors or communications issues in a timely manner for prompt resolution
• Track and trend audit results, providing feedback effectively and professionally to management
• Identify and report on systemic issues which create ongoing quality concerns
• Generate monthly reports of audit findings and assist management with information requests
• Produce other ad hoc reports as requested by internal and external clients
• Provide training, mentoring, and support to quality and operations staff
• Function as a subject matter expert, conducting routine to complex audits generally related to multiple functions on multiple systems platforms for multiple lines of business
• Work proactively and independently, including facilitation of calibration sessions with clients and/or teams

Requirements

• High school diploma or equivalent (GED)
• Minimum 5 years' experience in quality assurance or a related field

Qualifications

• High school diploma or equivalent (GED)
• Minimum 5 years' experience or any combination of education and experience which would provide an equivalent background

Nice to Have

• Pharmacy tech experience
• Pharmacy experience

Benefits