Pharmacy Quality Assurance Specialist
Elevance Health

Pharmacy Quality Assurance Specialist

Location: The employee must live within 50 miles of an open access Elevance Health PulsePoint (within 50 miles of the posted location).

Schedule: This is a Hybrid 1 (home/office) position. The employee must work in the office 1-2 days per week.

The Pharmacy Quality Assurance Specialist will be responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment 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, groups, and/or policyholders.
• 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 effectively and professionally to management.
• Identifies and reports on systemic issues which create ongoing quality concerns.
• Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
• Produces other ad hoc reports as requested by internal and external clients.
• Provides training, mentoring and support to quality and operations staff.
• Associates at this level function as subject matter experts, conducting routine to complex audits, generally related to multiple functions on multiple systems platforms for multiple lines of business.
• Works proactively and independently including facilitation of calibration sessions with clients and/or teams.

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 Experience:

• Working knowledge of insurance, call center, quality and pharmacy industry and medical terminology, and in-depth 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.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $26.87/hour to $43.96/hour

Locations: California; Colorado; District of Columbia (Washington, DC), NJ; Nevada; New York; Washington State

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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