Genesis10 is seeking new College Grads to join our Minneapolis team as Benefit Quality Assurance Analysts!
Job Description:
This position is responsible for ensuring that benefit design parameters are implemented in the RxCLAIM pharmacy adjudication system and the Benefit Edit Tool plan database management program according to customer/client requirements. This position also ensures that company standards, company processes, and contractual requirements are followed and being met. Plan design and specifications are reviewed for overall integrity, quality, effectiveness, and claim adjudication accuracy.
Responsibilities:
Establish and maintain quality procedures utilized by the quality assurance department to ensure claim adjudication and plan set-up accuracy.
Create and analyze quality reports in a format that documents the quality process and plan testing results. Provide reports to clients, as requested and/or required, for approval.
Interface and communicate with clients and benefit design and QA staff on plan testing results and plan testing needs.
Track quality results and statistics in a systematic and measurable format.
Provide analysis of errors to management, at regular intervals, outlining and summarizing the errors. Provide recommended enhancements, procedure changes, and training format to prevent future errors.
As new procedures and workflows are established, update the quality assurance documents to account for the changes and enhancements in the quality review process.
Develop and update test scripts to incorporate new plan testing needs into the automated testing process.
Assist with and/or complete impact reports of various plan set-up errors according to client guidelines and requirements and per Standard Operating Procedures.
Writes clear concise impact report findings including overall condition, cause, and effect.
Utilize the web-based Benefit Edit Tool to receive incoming benefit design work items from clients. Evaluate submissions of standard client benefit plan designs in order to appropriately code and document benefits for new business and for renewal of plan design changes.
Implement global benefit plan changes or updates in the claims processing system as defined by the consultant analytical team.
Research and respond to internal and external referrals and inquiries regarding benefit coding or claims processing. Utilize the Client's Call
Tracking database to reply to customer and pharmacy inquiries as escalated by the Contact Center. Ensure timely response to inquiries.
Required Experience:
Associates Degree in Pharmacy Tech
Must be a US Citizen
MS Office Applications
Strong attention to detail
Ability to stay focused while performing heads-down work
Self-starting with a strong work ethic
Able to manage time effectively
Excellent team attitude with strong interpersonal and group communication skills
Professional demeanor
Desire to work in corporate environment
Personal accountability
If you have the described qualifications and are interested in learning more about this exciting opportunity APPLY NOW!
About Genesis10:
Genesis10 is one of the fastest growing, privately-held business and technology firms in the U.S. – growing organically at an annualized rate of 38 percent since establishment by Harley Lippman in 1999. Genesis10 creates long-term sustainable partnerships with clients by providing resources and solutions to solve business needs. Genesis10 is an Equal Opportunity Employer, M/F/D/V.
Genesis10 - 12 months ago
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