Quality Assurance and Pharmacy Fraud Analyst

Company Description

At EVERSANA, we are proud to be certified as a Great Place to Work across the globe. We’re fueled by our vision to create a healthier world. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us! 

Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs.  We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve.   We are EVERSANA.  

Job Description

THE POSITION:

The Analyst, QA & Pharmacy Fraud is primarily responsible for the quality assurance and analysis of patient affordability programs, specifically for the pre- and post-implementation of pharmaceutical or medical device coupons, vouchers, and copay card programs utilized in a pharmacy or medical setting. This role provides auditing against program expectations and parameters outlined by business rule documents, contracts, program operations leaders, and clients as well as state and federal laws.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by

• Analyzes and communicates findings in monthly dashboard of daily, weekly, and monthly analysis of business rule violations and pharmacy fraud detections
• Works with third-party administrators to initiate pharmacy audits and follows through to completion within timeframes outlined in service level agreements
• Creates and reviews test case scenarios to ensure accuracy prior to go live and continues post-go live in accordance with SOP’s
• Analyzes Data trends and SLAs and provides insight both internally and to clients
• Partner with clients to act on Data trends and insights
• Develops collaborative relationships across EVERSANA departments, client teams and agency partners to accomplish client goals, program rollouts, and enhancements
• Monitors program operations to ensure adherence to business rules, contract commitments, and quality expectations
• Uses pharmacy, beneficiary, and various health care data and analytic tools to assemble, prepare, and analyze information in support of policy and business decision making
• Develops report criteria to monitor changes and business rules of programs
• Creates and adheres to quality standards and follows all SOWs, SOPs, and other requirements
• Collaborates with Client Engagement Partners to support and participate as needed in quarterly business reviews
• Identifies and assists in resolution of data issues, escalating timely to management and/or client to expedite resolution
• Contributes to team and self-development through ongoing process improvement initiatives, knowledge sharing, and quality reviews.
• Identifies and influences systemic changes to improve data deliverables and outcomes, quality, and services.
• Translates business questions into data requests and subsequently translates data into actionable information
• All other duties as assigned

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Qualifications

EXPECTATIONS OF THE JOB:

• Maintain strict confidentiality for all account activity.
• Respond promptly to customer needs and solicits client feedback to improve service.
• Foster ethical and responsible decision making as a proactive client advocate and EVERSANA representative.
• Assist in the development and implementation of enterprise growth through strong internal company relationships.
• Ensure the accurate, complete, and appropriate disclosure of clientele information.

The above list reflects the general details necessary to describe the expectations of the position and shall not be construed