Pharmacy Benefits QA Analyst

Remote

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health-Tech, Pharmacy Benefit ManagementIndustries

Requirements

Candidates must have a Bachelor's degree or equivalent work experience in healthcare and/or PBM, with at least 4 years of experience as a Pharmacy QA Analyst preferred. Comprehensive knowledge of benefits administration, configuration, eligibility requirements, benefit provisions, and enrollment protocols is required, along with robust analytical skills and advanced Microsoft Excel proficiency. Strong communication skills, a self-starter mentality, an execution-focused ethos, and flexibility to adapt under pressure are also essential. Applicants must reside in one of the specified states.

Responsibilities

The Pharmacy Benefits QA Analyst will oversee core operations, processes, and quality standards for benefits plan build and maintenance to ensure product quality. Responsibilities include communicating project status, escalating issues, collaborating with engineers on system enhancements, and becoming a subject matter expert on department standards. They will enhance test plans, support business application systems, maintain plan data integrity, capture department metrics, identify quality improvement opportunities, and develop/deploy daily audits to assess the work of Benefit Configuration Specialists/Analysts. The role ensures the quality and accurate analysis of benefit plan designs throughout their lifecycle.

Skills

Quality Assurance

Benefits Plan

Process Improvement

Data Analysis

Problem-Solving

Attention to Detail

SmithRx

Pharmacy benefit management with transparent pricing

About SmithRx

SmithRx operates as a Pharmacy Benefit Manager (PBM) that focuses on managing prescription drug plans for self-insured employers and plan sponsors. The company uses a transparent pricing model called "Pass Through Pricing," where it charges only an administrative fee and passes all rebates from prescriptions directly to clients and their members. This model contrasts with traditional PBMs that often inflate drug prices and retain rebates for profit. SmithRx's clients benefit from a technology platform that utilizes real-time data to improve service delivery, ensuring efficient and high-quality pharmacy benefit management. The company also provides a concierge service to enhance support for both members and clients. SmithRx aims to simplify pharmacy benefits while maximizing value for its clients through transparency, advanced technology, and exceptional customer service.

San Francisco, CaliforniaHeadquarters

2016Year Founded

$94.8MTotal Funding

SERIES_CCompany Stage

HealthcareIndustries

201-500Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Health Savings Account/Flexible Spending Account

Unlimited Paid Time Off

Paid Holidays

Wellness Program

Commuter Benefits

Parental Leave

Mental Health Support

Professional Development Budget

Risks

Increased competition from technology-driven PBMs like Capital Rx could erode market share.

Rapid technological advancements may require costly updates to SmithRx's platform.

Potential regulatory scrutiny on PBM pricing models could impact SmithRx's business model.

Differentiation

SmithRx uses a transparent 'Pass Through Pricing' model, unlike traditional PBMs.

The company leverages real-time data for efficient pharmacy benefit management services.

SmithRx offers concierge-level service, enhancing customer satisfaction and support.

Upsides

SmithRx secured $60M in Series C funding, indicating strong investor confidence.

Partnership with Banjo Health enhances prior authorization processes using AI technology.

Collaboration with TheracosBio offers cost-effective drug options for Type 2 Diabetes.

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