PMB QA

Role & responsibilities

Working on Commercial line of business BC & WPD plans, assisting in analyzing client benefit plan requirements and translating them into configuration specifications within the PBM system.

• Expertise in scrubbing the work from Salesforce (COM2) and create Jira tickets for client requirements.
• Hands on experience in benefit central and benefit builder applications.
• Ability to coordinate with the Leads and Onshore partners to analyze the benefit requests and get it done as prioritize basis.
• Ability to complete the assigned tasks on time, Understand the SLAs and ensure they are met timeline.
• Perform quality checks and UAT environment on CarelonRx applications to ensure compliance with internal and external requirements.
• Validate claims data against benefits and clinical requirements across different LOBs within CarelonRx.
• Support audit and compliance activities by maintaining proper records and documentation.
• Collaborate with business analysts and operations teams to resolve quality issues.
• Adhere to SOPs and contribute to continuous improvement initiatives.

Preferred candidate profile

Requires a Graduation / post-graduate degree in healthcare, pharmacy, business administration, or a related field.

• PBM (Pharmacy Benefit Management) Software Experience Strongly preferred
• Pharmacy Claims Audit Strongly preferred.
• Experience working in an Agile environment strongly preferred
• Ability to manage multiple projects and meet deadlines in a fast-paced environment.
• Strong communication and interpersonal skills, with the ability to collaborate effectively with diverse teams.
• 0-2 years of experience in the US Healthcare and PBM domain (Commercial/Medicaid /Medicare) in Business Analysis