Pharmacy Quality Assurance Specialist

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.

A proud member of the Elevance Health family of companies, CarelonRx leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.

CarelonRx's Advanced Home Delivery and Specialty Pharmacy is looking to hire a Quality Assurance (QA) Specialist .

This Pharmacy Quality Assurance Specialist, reporting to the Director of Pharmacy Quality Assurance, will be responsible for evaluating the quality of services and interactions provided by home delivery and specialty pharmacy associates. Included are processes related to prescription fulfillment and billing and claims processing, as well as customer service written and verbal inquiries.

How you will make an impact:

• Evaluates the quality and accuracy of transactions and/or communications with providers, and/or patients. Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.

• Tracks and trends audit results, providing feedback to management. Identifies and reports on systemic issues which create ongoing quality concerns.

• Generates monthly reports of audit findings, supports quality team with issues identified and develops reports to assist management with information requested.

• Produces other ad hoc reports as requested by internal and external clients.

• Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.

Minimum Requirements:

• Requires high school diploma or equivalent (GED); minimum 5 years’ experience or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Experience in mail order or high-volume pharmacy preferred.

• Working knowledge of insurance industry and medical terminology and detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred.

• Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred.