QA Specialist, Home Delivery Pharmacy
Anthem Blue Cross & Blue Shield
Position Title:QA Specialist, Home Delivery Pharmacy
QA Specialist, Home Delivery Pharmacy
A proud member of the Elevance Health family of companies, CarelonRx leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.
CarelonRx's Advanced Home Delivery and Specialty Pharmacy is looking to hire a QA Specialist. This Pharmacy Quality Assurance Specialist, reporting to the Director of Pharmacy Quality Assurance, will be responsible for evaluating the quality of services and interactions provided by home delivery and specialty pharmacy associates. Included are processes related to prescription fulfillment and billing and claims processing, as well as customer service written and verbal inquiries. This position will work in a hybrid way one day a week from an Elevance Health corporate office location.
How you will make an impact:
Evaluates the quality and accuracy of transactions and/or communications with providers, and/or patients. 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 to management. Identifies and reports on systemic issues which create ongoing quality concerns.
Generates monthly reports of audit findings, supports quality team with issues identified and develops reports to assist management with information requested.
Produces other ad hoc reports as requested by internal and external clients.
Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.
Requires high school diploma or equivalent (GED); minimum of 3 years experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
Highly preferred skills and experiences:
-Experience in mail order or high volume pharmacy preferred.
-Working knowledge of insurance industry and medical terminology and detailed 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.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $44,969 to $80,920
Locations: California; Colorado; Nevada; New York; Washington State; Jersey City, NJ
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, nondiscriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount
is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Job Level:Non-Management Non-Exempt
Workshift:1st Shift (United States of America)
Job Family:QLT > Audit
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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 as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.