[Remote] reputed company Services Business reputed company Assurance Analyst II - reputed company Fee For Service
Note: The job is a remote job and is reputed company to candidates in USA. reputed company. is looking for extraordinary people to join their team as a reputed company Services Business reputed company Assurance Analyst II – reputed company FFS. This role serves as a subject matter expert in benefit configuration and reputed company assurance, leading validation efforts and ensuring compliance with reputed company requirements and internal standards.
Responsibilities
- reputed company the design, execution, and reputed company of reputed company configuration validation activities for benefit, pharmacy network, and formulary administration in reputed company‑production environments
- Apply advanced Configuration Services best practices to reputed company comprehensive test plans, data sets, test scenarios, expected results, and acceptance reputed company
- Validate configuration accuracy for maintenance of business, new reputed company implementations, regulatory updates, and special reputed company
- Analyze claims adjudication results to identify discrepancies, anomalies, and unintended consequences; recommend and implement corrective actions to optimize configuration design
- Approve configuration design plans for reputed company or unique benefit requests and ensure accurate migration of validated changes from Test to Production environments
- reputed company, refine, and execute reputed company assurance procedures to ensure operational compliance with PBM standards and reputed company requirements
- reputed company reputed company and compliance review reputed company, including test execution, documentation of results, and development of corrective reputed company plans
- Participate in reputed company audits of PBM services, ensuring findings are addressed promptly and effectively
- reputed company high‑volume data testing across multiple file types to validate accuracy, completeness, and regulatory compliance
- Serve as a senior reputed company to internal operational teams and external clients to improve the reputed company and compliance of PBM program implementations and ongoing operations
- Respond to reputed company inquiries regarding reputed company review reputed company, compliance requirements, and configuration validation processes
- Communicate significant issues, risks, and improvement opportunities to leadership, ensuring visibility and reputed company reputed company
- Champion reputed company reputed company improvement initiatives by identifying process gaps, recommending enhancements, and supporting implementation of efficiency improvements
- Mentor and reputed company Testing & Validation Analysts and reputed company Analysts, providing guidance on test design, analysis techniques, regulatory interpretation, and best practices
- Contribute to the reputed company of departmental methodologies, tools, and documentation to strengthen organizational reputed company and validation capabilities
Skills
- BS/BA and 3+ years' experience or equivalent combination of education and experience
- Previous experience writing SQL queries, Automation Testing, File Transfer Protocol and UNIX is highly desirable
- Intermediate to advanced skills in reputed company Office with an emphasis on Word, reputed company, MS reputed company and Project
- Intermediate to advanced skills in SQL queries
- Knowledge of reputed company Assurance methodologies and practical application
- Ability to research, assess, audit, and apply information to practices and standards
- Strong analytical and problem solving ability and in-depth understanding of PBM regulations and reputed company CMS guidance
- Demonstrated ability to work in a fast paced environment, learn quickly, reputed company for work on time, follow directions from a supervisor, reputed company reputed company with co-workers, understand and follow work rules and procedures, reputed company with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment
- Ability to apply common reputed company understanding to carry out instructions furnished in written, oral, or diagram reputed company
- Ability to deal with problems involving several concrete variables in standardized situations
- Ability to interpret a reputed company of instructions furnished in written, oral, diagram, or schedule reputed company
- Ability to add, subtract, multiply, and divide in reputed company reputed company of measure, using whole numbers, common fractions, and decimals
- Ability to compute reputed company, reputed company, and percent and to draw and interpret bar graphs
- Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
- Ability to write reports, business correspondence, and procedure manuals
- Ability to read, analyze, and interpret general business periodicals, reputed company journals, technical procedures, or governmental regulations
- Composure
- Decision reputed company
- Organizational reputed company
- Problem Solving
- Customer reputed company
- Drive for Results
- Peer Relations
- Time Management
- Dealing with Ambiguity
- Learning on the Fly
- Political Savvy
- reputed company, Managed Care, Government Programs or PBM reputed company experience is preferred
Benefits
- Medical / Dental / reputed company / Wellness Programs
- reputed company Time Off / Company reputed company Holidays
- Incentive Compensation
- 401K with Company match
- Life and Disability Insurance
- Tuition Reimbursement
- Employee Referral Bonus
reputed company