qa analyst.

I am looking for someone to work remotely as a QA Analyst. This person MUST HAVE PBM (Pharmacy Benefit Manager) experience. This individual also must have claims processing, data management, QA, and problem solving/crititcal thinking skills and experience. 

• Fully Remote 
• $40/Hour+ (open to negotiation) 
• Starting ASAP 

If you have PBM and Claims experience and you are interested in learning more, please send your resume to jenni.josten@randstadusa.com for immediate review. 

salary: $40 - $50 per hour
shift: First
work hours: 8 AM - 4 PM
education: Bachelors

Responsibilities

 Responsible for providing quality assurance for internal processes and suggesting additional additions, when
appropriate.
 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 adequate
knowledge 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

Quality Assurance

PBM

SQL

Managing Tickets

HIPAA

Qualifications

Years of experience: 4 years

Experience level: Experienced

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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.