Team Leader, Pharmacy Claims Quality Assurance

Abarca Health

Team Leader, Pharmacy Claims Quality Assurance

  • San Juan, PR or Remote – US

What you’ll do

In a few words…

We’re in need of a Team Leader, Pharmacy Claims Quality Assurance, do you qualify? You’d need to ascertain quality while you manage and provide direction to the Quality staff regarding prioritization of tasks, quality of all team work-product deliverable, new employee training and adherence to deadlines. We’d look to you to develop and direct the timely performance and completion of all our quality assurance activities. In particular, you’d be testing and monitoring activities as part of projects, ensuring that new business/functional requirements and new clients’ implementations are developed/configured on our systems as intended by the business stakeholder and ensure the quality of the systems and processes supporting the company’s operation. We’d expect you to understand business requirements and technical specifications, identify and define testing scenarios, and create, execute and document test cases/scripts conducted to existing functionalities, as well as to new features and/or fixes deployed to our systems.

You would work with other key areas to ensure the quality and integrity of business requirements testing and monitoring efforts. You would make recommendations for corrective action and process/system improvement based upon testing and monitoring results. It’s all doable but requires an obsession with quality and a deep knowledge of both the technical and operational sides of the business. We’re rooting for you!

The fundamentals for the job…

  • In this role you’d be monitoring overall department performance and managing the development, coordination and administration of the Quality Assurance team, including setting, reviewing and measuring quality standards, documentation standards, processes and procedures.
  • You would also conduct performance reviews, quarterly/semiannual check-ins and staff meetings to guide performance management and employee development efforts and direct them toward departmental goals, including quality and process improvement efforts.
  • We’d look to you to lead efforts to continually improve the testing and monitoring activities to ensure the quality of the systems and processes supporting the company’s operation.
  • You’ll be the best at leading the preparation and implementation of quality assurance activities such as testing, policies, procedures, workflows and training.
  • You will develop, track and report key quality metrics to monitor and report on testing and quality efforts and results to business stakeholders and company leads.
  • You will also develop, supervise and perform quality assurance of benefit set-up, network, pricing and formulary configurations.
  • It’s up to you to define and lead the process to document and track issues identified during testing activities to ensure issue resolution and testing completion.
  • We need you to contribute to the business requirement gathering process by identifying missing requirements based on test cases development and testing experience.
  • You will collaborate in the development of new ideas (of which you have many) and requirements to resolve testing and system’s issues, and improve current systems based on testing results.
  • You will lead the development and improvement of testing strategies, techniques, procedures, and tools, as well as lead the development of policies and procedures related to testing and quality activities.
  • You will participate on projects and new clients’ implementations to gather understanding on new system functionalities and requirements that will require testing and/or monitoring.
  • You should understand and document system logics and/or processes, as well as create and conduct training on system logics and/or processes.
  • You will collaborate and support users during issue solving activities, new business requirements gathering, and day-to-day system operation.
  • We expect you to collaborate inter-departmentally with key areas within the organization.
  • In addition, you’ll participate in the Change Advisory Committee Meetings and coordinate with testing and special monitoring schedules and plans when new functionalities are implemented.
  • You will be the lead the implementation and continuous development of any systems and/or tools used to support the Quality Assurance activities.

What you’re made of

The bold requirements…

  • You need a Bachelor’s Degree; if it’s in Engineering, Biology, or related clinical discipline, that would be a plus. (In lieu of a degree, equivalent relevant work experience may be considered.)
  • You need 4+ years of related experience with SDLC and QA is preferable.
  • A minimum 4 years’ experience in a healthcare non-retail pharmacy setting (preferred).
  • If you bring a strong understanding of PBM Operations and Medicare Part D, that’s a really great plus.
  • Your prior understanding in quality, audit, controls, and business process improvements is also a cool plus.
  • You have great analytical, strategic and critical thinking skills, are very organized, innovative, accountable, and work well collaboratively.
  • You have excellent writing, planning and negotiating skills; your presentation skills are excellent and you also have strong problem-solving abilities. Your attention to detail is legendary.
  • You are willing and able to utilize dashboard tools, e.g. Tableau, QVW and Excel tools.
  • Your knowledge in database, data structure and SQL is a super duper plus.
  • Your knowledge of quality assurance practices and tools is yet another plus.
  • We’d prefer it if you brought training and experience in testing methodologies.
  • Computer proficiency, knowledge of Microsoft Office products, knowledge of Excel at a minimum intermediate user level, and Internet experience.
  • You must be able to communicate effectively (read, speak, write, lead, and qualify) in English and Spanish.

That something extra we´d love to see…

  1. Analytical: You value the power of context & enjoy examining the past. You understand the present by analyzing events leading up to it. This method of cold and calculated thinking helps you get things done when everyone else freaks out.
  2. Detail oriented: Nothing gets by you and you rarely forget a thing. When learning some new procedure, you’re the type to take notes. When everyone else is still lost, you’re already at the next steps. Others count on this skill of yours.
  3. Strategic: You set a vision and devise alternative ways to proceed. In any given scenario, you quickly spot the relevant patterns and issues. You always win when playing Pairs.
  4. Collaborator: On a quest to find (or generate) harmony and consensus. Not a popcorn-bringing conflict-spectator, instead preferring to seek areas of mutual agreement. Inherently understand that a good deal is, essentially, when everyone walks away a little bit peeved.
  5. Problem solver: You provide comprehensive answers to complications or problems, keeping in mind both internal and external needs. You’re always part of the solution (not the precipitate).