Note: The job is a remote job and is open to candidates in USA. MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join their team as a Client Services Business Quality Assurance Analyst II – Medicaid FFS. This role serves as a subject matter expert in benefit configuration and quality assurance, leading validation efforts and ensuring compliance with client requirements and internal standards.
Responsibilities
- Lead the design, execution, and oversight of complex configuration validation activities for benefit, pharmacy network, and formulary administration in pre‑production environments
- Apply advanced Configuration Services best practices to develop comprehensive test plans, data sets, test scenarios, expected results, and acceptance criteria
- Validate configuration accuracy for maintenance of business, new client implementations, regulatory updates, and special projects
- 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 complex or unique benefit requests and ensure accurate migration of validated changes from Test to Production environments
- Develop, refine, and execute quality assurance procedures to ensure operational compliance with PBM standards and client requirements
- Lead quality and compliance review projects, including test execution, documentation of results, and development of corrective action plans
- Participate in internal and external audits of PBM services, ensuring findings are addressed promptly and effectively
- Perform high‑volume data testing across multiple file types to validate accuracy, completeness, and regulatory compliance
- Serve as a senior liaison to internal operational teams and external clients to improve the quality and compliance of PBM program implementations and ongoing operations
- Respond to complex inquiries regarding quality review outcomes, compliance requirements, and configuration validation processes
- Communicate significant issues, risks, and improvement opportunities to leadership, ensuring visibility and timely resolution
- Champion continuous quality improvement initiatives by identifying process gaps, recommending enhancements, and supporting implementation of efficiency improvements
- Mentor and coach Testing & Validation Analysts and Quality Analysts, providing guidance on test design, analysis techniques, regulatory interpretation, and best practices
- Contribute to the evolution of departmental methodologies, tools, and documentation to strengthen organizational quality 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 Microsoft Office with an emphasis on Word, Excel, MS Access and Project
- Intermediate to advanced skills in SQL queries
- Knowledge of Quality 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 related CMS guidance
- Demonstrated ability to work in a fast paced environment, learn quickly, appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
- Ability to deal with problems involving several concrete variables in standardized situations
- Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
- Ability to compute rate, ratio, 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, professional journals, technical procedures, or governmental regulations
- Composure
- Decision Quality
- Organizational Agility
- Problem Solving
- Customer Focus
- Drive for Results
- Peer Relations
- Time Management
- Dealing with Ambiguity
- Learning on the Fly
- Political Savvy
- Healthcare, Managed Care, Government Programs or PBM Quality experience is preferred
Benefits
- Medical / Dental / Vision / Wellness Programs
- Paid Time Off / Company Paid Holidays
- Incentive Compensation
- 401K with Company match
- Life and Disability Insurance
- Tuition Reimbursement
- Employee Referral Bonus
Company Overview
MedImpact is the nation’s largest independent health solutions and pharmacy benefit company, serving commercial health plans, government programs, self insured/employer groups, and millions of consumers. It was founded in 1989, and is headquartered in San Diego, California, USA, with a workforce of 1001-5000 employees. Its website is http://medimpact.com.