Manager, Quality Assurance (Remote)

at Prime Therapeutics in Springfield, Illinois, United States

Job Description

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

Manager, Quality Assurance (Remote)

Job Description Summary

Responsible for managing, coaching and developing the Benefits Plan Administration team across multiple lines of business (Medicare Part D, Employer, Government, Coupons, Managed Medicaid, Migrations, etc.) to ensure benefit plans are programmed appropriately and consistently and performance guarantee, service level agreements and operational goals are met; creating project plans and analysis to ensure project deadlines are met; acquiring a solid knowledge of all phases of the department within the established long and short range department objectives; and providing training to new and less experienced benefit analysts. Interfaces directly with customers, members and/or providers to resolve customer complaints. Assumes additional responsibilities in the absence of the Director.

Job Description

+ Operations: Manages team members in the project management, programming, testing and documentation aspects of the analyst responsibilities to drive the highest level of performance and meet or exceed service level agreements; develops, recommends and implements plan(s) of action to implement recommended programming changes to increase efficiency and performance. Reports performance results to team and management. Demonstrates flexibility in assigning resources based on business needs. Creates project plans and performs analysis to ensure project (i.e., migrations, new plan implementations) deadlines are met. Obtains an in-depth working knowledge of the benefits departments’ workflow and the impact to other departments. Adheres to budget allocations.

+ Team Performance and Workforce Management: Manages employee performance through defined employee scorecards and performance metrics. Provides ongoing feedback and coaching to ensure performance targets are met. Recognizes and rewards effectively; provides appropriate levels of direction and support. Consistently follows corporate and departmental polices and guidelines. Utilizes corporate tools for performance appraisals; engages team members in development planning and progress. Identifies training needs within the team; works independently and/or through other sources to develop a training plan. Maintains a positive work environment that supports self-directed teams; provides a structure to optimize the experience, skill, knowledge and capability of the team; facilitates collaboration among team members. Schedules employees, tracks productivity, maintains work schedules, coordinates different activities, and approves time off and overtime. Provides administrative backup support to ensure appropriate workflow is being maintained at all times.

+ Develops and documents workflow, systems requirements, system impact analysis, systems design, process analysis and testing (including reasonableness checks) using software development methodology to provide efficient, cost-effective solutions as directed.

+ Identifies impact of solutions on existing and future systems. May perform operational activities.

+ Identifies reporting needs based on system programming and workflows and documents reporting requirements and testing of new reporting development prior to implementation to Production.

+ Participates in initiatives or projects that support process improvements, leveraging new system capabilities or the integration of data/other applications into existing systems.

+ Collaborates between departmental business owners, end users, IT, Contact Center, Claims and Clinical departments to resolve issues, or develop small to large sized new programs. Participates in full life cycle of projects impacting Plan Administration by performing requirements analysis, process development and design, and unit testing. Participates in initiatives or projects that support process improvements, leveraging new system capabilities or the integration of data/other applications into existing systems.

+ Creates and maintains the necessary functionality in our ticketing system, benefit landscape, and workflows. Conducts root cause analysis, gathering data to pinpoint problem areas on which to focus. Recommends and implements solutions and evaluates results, and implements controls to monitor consistent use of the solution.

+ Data Validation: Performs the technical and administrative functions to lead the Benefit Analysts in organizational data validation projects to support major system enhancements, or release updates. Supports data validation activities when deploying changes to a large number of clients. Leads design of data validation processes to ensure data checks fall within an acceptable range to ensure compliance standards are met. Activities should automate data validation, improve quality, and reduce costs. Assist with phased deployment approach to ease adoption across impacted teams.

+ Audits: Coordinates responses to both external and internal audits. Ensures workflows support compliance, and identifies when audit protocols need to be refreshed to more accurately capture day-to-day procedures. Evaluates audit findings and implements new processes to bring Plan Administration into compliance.

Responsibilities

+ Bachelor’s degree required with a minimum of 5 years’ PBM Benefit Analyst experience.

+ Will substitute 2 additional years of PBM Benefit Analyst experience for the bachelor’s degree.

+ 3+ years’ supervisory experience in appropriate PBM technical environment required or demonstrated leadership proficiency.

+ Ability to analyze benefit plans and programming rules to demonstrate a benefit structure with an automated claims processing system.

+ Ability to understand the systems functionality and business policies.

+ Excellent organizational, interpersonal and communication skills.

+ Ability to maintain production levels and quality goals.

+ Strong analytical, technical and problem solving skills.

+ Ability to train employees on all products, procedures and systems across multiple lines of PBM business.

+ Detail oriented; customer/team advocate; flexibility; positive attitude.

+ Team player; problem solver.

+ Ability to manage multiple tasks simultaneously; initiator; change agent; coach; leader.

+ Must be willing to travel up to 10% of the time.

Work Experience

Work Experience – Required:

PBM (Pharmacy Benefit Management), Supervisory

Work Experience – Preferred:

Education

Education – Required:

A Combination of Education and Work Experience May Be Considered., Bachelors

Education – Preferred:

Certifications

Certifications – Required:

Certifications – Preferred:

Potential pay for this position ranges from $73,580.00 – $117,720.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer and a Tobacco-free workplace . We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. _Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contrac