Remote QA Analyst

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make. Job Posting Title Remote QA Analyst (PBM Ops) **Job Description**: **Responsibilities**: - Perform research and assist leadership in identification of potential missed turnaround times on review related to applicable quality tests - Perform ongoing inter-rater reliability exercises and quality reviews for less tenured staff and provide performance feedback and information to identify areas of improvement - Perform complex quality reviews and analysis of cases to prevent errors based on strict compliance, service level agreements, and regulatory guidance - Discover outliers and areas of improvement on work product of reviewers; provide feedback for improvement to prevent quality issues - Assist in the gathering, documenting, and implementations of requirements for new and future system enhancements - Serve as liaison for directing unresolved issues for further evaluation and resolution - Collaborate with trainers and writers to provide feedback for training modules and documentation - Other duties as assigned Minimum Qualifications - Bachelor’s degree in Business, Liberal Arts, or related area of study, or equivalent combination of education and/or related work experience; HS diploma or GED is required - 2 years of experience within Claims Processing, Audit, Quality or Pharmacy - Must be eligible to work in the United States without need for work visa or residency sponsorship If position sits within Clinical Review Department, the following qualifications are also required: - 1 year of experience as a Clinical Review Technician or 2 years of experience in Clinical Review If position sits within Pharmacy Audit department, the following qualifications are also required: - National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) - 2 years of experience working directly in a pharmacy Additional Qualifications - Strong organizational, analytical, interpretive, and time management skills - Ability to make consistent and unbiased decisions - Strong interpersonal, verbal and written communication skills - Ability to provide work direction to others - Ability to work under strict timelines while managing multiple priorities simultaneously - Ability to analyze data using analytical tools (e.g. Microsoft Excel) Preferred Qualifications - National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) or Licensed Practical Nurse certification if working in Medicare - Healthcare, audit, and/or reporting and metrics environment experience - Experience using RxClaim - Experience in benefit design and review process for multiple clients - PBM or healthcare experience - Experience in PBM Operations department Minimum Physical Job Requirements - Ability to work in a flexible schedule which may include weekends, holidays, or shifts outside of Prime’s core business hours of 9:00am-3:00pm - Constantly required to sit, use hands to handle or feel, talk and hear - Frequently required to reach with hands and arms - Occasionally required to stand, walk and stoop, kneel, and crouch - Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds - Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus Reporting Structure - Reports to Supervisor, Manager, Director, or Senior Director in the PBM Operations, Clinical Review, Networks, or Pharmacy Audit Department Potential pay for this position ranges from $55,400.00 - $83,400.00 based on location, experience and skills. - To review our Benefits, Incentives and Additional Compensation, visit our - Benefits Page - and click on the "Benefits at a glance" button for more detail.