Claims Quality Assurance Specialist

Job Summary

A company is looking for a Specialist, Claims Quality Assurance.

Key Responsibilities

• Execute monthly quality assurance testing cycles and analyze results
• Validate adjudication results against various sources and prepare QA deliverables
• Design test scenarios and identify quality risks while supporting process improvements

Required Qualifications

• Bachelor's degree or equivalent work experience is required
• Pharmacy Technician License or National Certification preferred
• 5+ years of experience in quality assurance or data validation roles within a PBM or similar environment
• Intermediate proficiency in Microsoft Office and relevant reporting tools
• Prior experience with data analysis and defect tracking within a healthcare environment preferred