Senior Manager, Quality Assurance, Benefit Configuration

🔥 2 minutes ago

🐻 Alaska, Hawaii, +11 more states – Remote

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌾 North Dakota – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $108.4k - $135.5k / year

⏰ Full Time

🟠 Senior

🔧 QA Engineer (Quality Assurance)

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Lead and oversee a team of Quality Assurance Analysts, ensuring effective execution of benefit configuration testing, validation, and audit activities. • Ensure accurate and timely completion of complex quality assurance for new client implementations, benefit changes, and ongoing maintenance across all lines of business. • Establish and enforce quality assurance standards, procedures, and audit methodologies, ensuring compliance with internal requirements. • Provide oversight on root cause analysis, issue resolution, and corrective action planning, ensuring issues are identified, tracked, and resolved effectively by partnering with Issue Management Team. • Collaborate cross-functionally to drive process improvement, automation, and scalable initiatives to enhance efficiency, reduce risk, and improve testing outcomes. • Oversee development and maintenance of training materials, job aids, and standard operating procedures, ensuring consistency across the team. • Support and lead client interactions, including presentations, audits, implementations, and RFP responses related to quality assurance practices. • Ensure effective use of workflow management, issue tracking, and reporting tools to support visibility, accountability, and performance tracking. • Lead and inspire high-performing teams by providing strategic direction, aligning talent and resources with organizational goals, and driving operational excellence across key initiatives. • Other duties as assigned.

🎯 Requirements

• Bachelor's degree or equivalent work experience required. • 6+ years of relevant work experience in the healthcare industry in benefit confirmation, operations, or quality assurance required. • PBM experience preferred. • 5+ years of experience leadership in PBM, healthcare operations, or similar industry required. • 4+ years of work experience using MS Excel filtering, sorting, and analyzing data with ability to write complex formulas required. • Strong PBM Quality Assurance validation and testing knowledge preferred. • Knowledge of government programs such as Medicare or Medicaid, network pricing, and formulary required. • Participate in, adhere to, and support compliance program objectives. • The ability to consistently interact cooperatively and respectfully with other employees.

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!