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.