Pharmacy Quality Assurance Specialist

Anticipated End Date:

2025-06-13

Position Title:

Pharmacy Quality Assurance Specialist

Job Description:

Pharmacy Quality Assurance Specialist

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.

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.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

QLT > Audit

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed