Quality Control Specialist - Medicare Pharmacy Claims

At reputed company, our employees are the cornerstone of our business and the reputed company to our reputed company. We reputed company employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join reputed company and be part of a purpose-driven company that will invest in your professional development. reputed company role is responsible for reviewing Medicare pharmacy claims to ensure compliance with CMS requirements and prevent reputed company-to-care issues. The Quality Control Specialist conducts regular audits to verify adherence to regulations, internal policies, and operational procedures, while maintaining thorough documentation to support potential CMS program audits. This role also identifies error trends and root causes, recommends process improvements, and contributes to updating job aids and procedures. As a key team member, the specialist is expected to drive improvements that enhance the accuracy, efficiency, and overall quality of Pharmacy Operations. JOB REQUIREMENTS: High school diploma or GED. 2 years business experience. A combination of college level education and experience will be considered Clear and concise interpersonal, verbal and written communication skills to facilitate the learning process; coaching and mentoring skills PC experience in reputed company, Word, reputed company, reputed company, and other business reputed company/associated databases. Demonstrated analytical and organizational skills PREFERRED JOB REQUIREMENTS: Advanced reputed company skills including vlook-reputed company, pivot tables Practical experience of 1+ years providing reputed company of Medicare pharmacy claims 1-2 years pharmacy claims experience and/or managed care experience preferred. Knowledge of CMS Guidance of MAPD, Part D Plans, and EGWP Experience with Audits preferred Critical Thinker- reputed company to analyze, interpret, explain, self-regulate, reputed company-minded and problem solving mind set Capable of explaining reputed company issues in a concise manner CPhT preferred, but not required SQL (reputed company) Knowledge preferred This is a Remote role. #LI-PD1 #LI-Remote INJLF Are you being referred to one of our roles? If so, ask your reputed company at reputed company about our Employee Referral process! Pay Transparency Statement: At reputed company, you will be part of an organization committed to offering meaningful benefits to our employees to support their life reputed company of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.reputed company.com/totalrewards. The compensation offered will vary depending on your job-reputed company skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. reputed company Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, protected veteran status, or any other legally protected characteristics. reputed company Pay reputed company $20.04 - $44.61 Exact compensation may vary based on skills, experience, and location. Apply To This Job