At UnitedHealth Group, their mission is to help people live healthier lives. To achieve this goal, they are focused on building a modern, adaptable, innovative and inclusive system of health care services.
Their scale and potential to improve health makes them one of the most visible stewards of America’s vast health care system. Entrusted with both important resources and responsibilities, they are involved on a daily basis in decision-making that has life-changing consequences for millions of Americans.
Post: Quality Specialist
Job Description:
Job Responsibilities:
Perform quality review of new and changed benefit plan set-up for accuracy including:
Review completed projects for accurate implementation based on project requests received;
Perform test claims (as applicable) and document results to ensure requests were completed accurately in the system;
Perform root cause analysis of errors identified (if applicable);
Assess and communicate financial impact of the errors identified to BOM management (if applicable);
Validate audit findings with affected parties and confirm corrected (if applicable);
Recommend solutions to mitigate/fix the errors noted and review them with affected parties for an agreed upon approach, as appropriate;
Document work performed and audit results based on pre-determined standards and guidelines.
May be assigned to work on special projects and business initiatives.
Reporting:
Assist with inquiries from Proposal Unit, Client Management, Clinical, and other internal partners on data requests including:
Create spreadsheets and macros, compile, analyze data in an efficient and effective manner;
Present data in a detailed and summary level for different level of reviews;
Provide detailed input to root-cause analysis and resolution for errors identified.
Work within a team to support all quality review data reporting needs within BOM or special projects.
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System Testing:
Perform User Acceptance Testing (UAT) to ensure system changes and/or enhancements are properly tested and acceptable prior to implementation including:
Develop test plan based on business requirements;
Perform regression testing (as applicable);
Identify, report defects and assign risks (as applicable);
Clearly document work performed and communicate results to BOM management for review/approval; and
Communicate to all BOM staff the impact of the changes or enhancements.
Actively work together with other business groups within Prescription Solutions to ensure overall business objectives are met.
Desired Profile:
Qualifications:
Certified pharmacy technician preferred;
Microsoft Office proficiency, specifically Advanced Excel skills -- must have ability to create Excel spreadsheet, macros, compile/analyze data for reporting;
Strong written and verbal skills;
Detail-oriented;
Analytical skills;
Bachelor's Degree or equivalent experience;
2+ years of RxCLAIM (by SXC) experience (desired);
2+ years PBM or retail pharmacy experience (required);
System testing experience;
Ability to develop test plan based on business requirements; and
Possess strong audit, controls, and business process improvements understanding (Six Sigma, Internal Audit)
Additional Information:
Exp: 2-3 Years
Location: Hyderabad
Education: Any
Industry Type: Pharma/ Biotech/Clinical Research
Functional Area: Other
End Date: 10th Sept., 2011
Job ID: 360129
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