Quality Analyst

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RxBenefits, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1995

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

💰 Private Equity Round on 2020-12

Healthcare Insurance • Fintech • B2B

RxBenefits, Inc. is a company that specializes in providing innovative pharmacy benefits solutions to employers and their employees. They focus on optimizing the management of prescription drug plans to reduce costs and improve health outcomes. Through advanced analytics and personalized member support, RxBenefits aims to transform the pharmacy benefits experience for their clients.

📋 Description

• Follow QA testing procedures to complete standard testing scenarios and reporting for the following and additional testing as assigned. • New client benefit implementations • Existing client benefit changes • Existing client benefit audits • Complete the following standard testing scenarios: • Documentation comparison • Structure set-up comparison • Review of automated Benefits test case output • Review of Integrated Accumulation sharing • Manual test case entry and review, using critical thinking to determine accuracy of test results • Use critical thinking skills in reviewing test data results, reaching out internally around complex situations (such as multiple inaccuracies, poorly defined criteria or missing details, escalations) to ensure the most accurate test results are provided. • Use Microsoft Excel to complete structure comparisons. • Use Microsoft Access to create test case details to apply for automated testing. • Learn all PBM documentation, software, and reporting systems for our contracted PBMs • Accurately document detailed test results; including location of issues found, screen shots and member examples as necessary. • Determine appropriate test plan based on the type of benefit changes. • Update or review process documentation, as assigned. • Assist with mentoring new or contract staff, as assigned. • Effective internal communication, including cross-department collaboration to explain and resolve testing failures • Identify and escalate process deficiencies and delays to supervision. • Identify and support process improvement opportunities. • Support new process and technology solutions, including associated user design development and user acceptance testing, as assigned. • Supports off-hours priority work as needed, including some holidays. • Effectively navigate Salesforce and/or proprietary software. • Manage day-to-day work in Clarizen project management software. • Positively accepts and promotes change. • Assumes additional responsibilities as prescribed or directed.

🎯 Requirements

• 2+ years of experience handling pharmacy claims • Proficient in MS Office (Including Word, Excel, Outlook) • Ability to handle multiple and competing priorities with little direction from leadership • Prior work experience leveraging professional written and oral communication skills; organization skills; and relationship management skills • Possess analytical and critical thinking skills • Pharmacy Tech strongly preferred • Prior data validation or implementation support experience preferred • Pharmacy Benefit Manager (PBM) or Retail Pharmacy experience preferred • Intermediate Excel skills and familiarity with Microsoft Access is a plus • Salesforce or Clarizen experience is a plus

🏖️ Benefits

• Remote first work environment • Choice of a HDHP or PPO Medical plan, we pay 100% of the premium for the HDHP for you and your eligible family members • Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance that we also pay 100% of premiums (for your family too on Dental and Vision) • Additional buy-up options for Short- and Long-Term Disability and Life Insurance • 401(k) with an employer match up to 3.5% available after 60 days • Community Service Day to give back and support what you love in your community • 10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving plus a floating holiday to use as you like • Reimbursements for high-speed internet, we’ll send you a computer and monitors to help you do your best work • Tuition Reimbursement for accredited degree programs • Paid New Parent Leave that can be used for adoption or birth • Pet insurance to protect your furbabies • A robust mental health benefit and EAP service through Spring Health to support you when you need it most