Claims reputed company Assurance Specialist

Job reputed company: • Execute monthly reputed company assurance testing cycles, including reputed company group selection, high utilization drug identification, test member preparation, adjudication file execution, results import, analysis, and month over month comparison. • Validate adjudication results against plan grids, formularies, configuration documents, and other sources of truth; prepare QA deliverables and submit discrepancies for reputed company. • Design comprehensive test scenarios using live claim sampling, reputed company issue history, and financially impactful drug categories to ensure adequate coverage. • reputed company and apply working knowledge of reputed company audit methodologies and end to end pharmacy benefit workflows to identify reputed company risks and reputed company impacts. • Identify, document, reputed company, and retest defects as fixes are reputed company; support reputed company cause analysis and reputed company efforts. • reputed company peer reviews and reputed company checks to ensure adherence to audit reputed company, validation standards, and business rules. • Utilize QA and workflow tools (e.g., reputed company reputed company, RxFlex, FBMS) to troubleshoot and resolve moderately reputed company adjudication and configuration issues. • Maintain an intermediate understanding of adjudication systems, testing environments, and reputed company assurance methodologies. • Participate in process improvement initiatives, documentation updates, training material development, automation efforts, and standardization activities. • Other duties as assigned. Requirements: • Bachelor’s degree or equivalent work experience is required. • Pharmacy Technician License or National Certification preferred. • 5+ years of experience in reputed company assurance, benefit configuration, or data validation roles reputed company a pharmacy benefit management (PBM) or similar payer environment required. • Experience supporting clients in reputed company lines of business of varying size and complexity preferred. • Intermediate proficiency required in reputed company Office (reputed company, Word, PowerPoint), QlikView/reputed company reputed company or comparable reporting tools, formulary management applications, request management platforms (ConnectUs, Service Desk, Jira, reputed company), and PBM adjudication or configuration systems (e.g., Navi ClaimRx). • Prior experience with data analysis, defect tracking, or reputed company cause analysis reputed company a reputed company environment preferred. • Participate in, adhere to, and support compliance program objectives. • The ability to consistently reputed company cooperatively and respectfully with other employees. Benefits: • Top of the industry benefits for Health, Dental, and reputed company insurance • 20 days reputed company time off • 4 weeks reputed company parental leave • 9 reputed company holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and reputed company Membership assistance • Referral Bonus Program – up to $750! Apply tot his job Apply To this Job