Company

Rite Aid

Job Type

Full time

Requisition

JR003083

Last Updated

2023-07-28

Department

Elixir Operations

Job Summary

The Testing and Quality Control Analyst is responsible for performing benefit design soundness through various internal methods to ensure systems are setup and maintained appropriately, allowing accurate claim adjudication. This position has no direct reports

Job Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Field questions from various levels of management pertaining to testing results
• Other duties as assigned
• Review and understand client specifications and benefit design builds through RxPlan and PharmScreens software platforms
• Serve as point of contact for other departments troubleshooting plan/benefit configuration related questions through claims testing
• Analyze and interpret test claims for processing and adjudication results to ensure configuration accuracy and compliance
• Conduct automated claims testing through RxPlan, analyzing results
• Build/Run standard and custom batch claim files for clients in all lines of business and benefit design complexities
• Report findings and follow through with resolution resulting from all analytical work, including but not limited to batch testing, benefit compares, automated claims testing, and applicable inquiries
• Document results and follow through resolution within department’s tracking system
• Perform benefit compare analysis between PharmScreens and RxPlan

REQUIREMENTS:

• Ability to independently identify, research, analyze, and resolve issues with minimal supervision
• Demonstrated ability to manage multiple priorities and deadlines
• Ability to work with peers in a team effort
• Oral and written communication skills with a high degree of professionalism
• Bachelor’s degree in health administration, business or related field; proven industry experience may be acceptable in lieu of degree

• Time management and organizational skills being able to handle multiple priorities in a fast-paced environment
• Ability to work extended hours, weekends, and holidays pursuant with industry demands
• Proficient in Microsoft Office and industry related software programs

PREFERRED QUALIFICATIONS:

• Medicare Part D knowledge
• Minimum 3 years of pharmacy claim analysis experience and/or PBM experience

Salary Range: $54,801 - $82,093

WORK ENVIRONMENT:

Includes a typical office environment, with minimal exposure to excessive noise or adverse environmental issues.

PHYSICAL REQUIREMENTS:

Ability to sit for prolonged periods of time.

qualifications

The typical starting salary for this listed role - Salary Range: $54,801 - $82,093

Fair Chance Act

Fair Chance Act Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Pursuant to the Los Angeles Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Pursuant to the California Fair Chance Act, we will consider qualified applicants with a criminal history. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if we identify a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. Find out more about the Fair Chance Act by visiting the Civil Right’s Department Fair Chance Act webpage.

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New Jersey Law Against Discrimination (LAD)

The New Jersey Law Against Discrimination (LAD) prohibits unlawful employment discrimination based on an individual's race, creed, color, national origin, nationality, ancestry, age, sex (including pregnancy), familial status, marital/civil union status, religion, domestic partnership status, affectional or sexual orientation, gender identity and expression, atypical hereditary cellular or blood trait, genetic information, liability for military service, and mental or physical disability (including perceived disability, and AIDS and HIV status).