Senior Manager, Quality Assurance - Benefit Configuration

16h16 hours ago

Navitus Health Solutions, LLC

US · Full-time · $108,429 – $135,536

About this role

Due to growth, Navitus is adding a Senior Manager, Quality Assurance Benefit Configuration to our team. This role leads the Quality Assurance function responsible for benefit configuration verification and accuracy, ensuring alignment with client requirements and internal quality expectations across all lines of business.

The Senior Manager oversees a team of Quality Assurance Analysts, driving execution of benefit configuration testing, validation, and audit activities. This ensures the accuracy and integrity of claims adjudication within the NCRx system, mitigating risks related to member access, compliance, and financial exposure.

Our team works in an environment that celebrates diversity, fosters creativity, and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other, collaborating cross-functionally to drive process improvement and automation.

This role offers the opportunity to establish and maintain quality assurance standards, processes, and workflows that support accurate, efficient, and scalable validation practices. You will lead client interactions and partner with the Issue Management Team to resolve complex issues and implement corrective actions.

Requirements

Experience in quality assurance within the pharmaceutical or pharmacy benefit management industry.
Knowledge of benefit configuration and claims adjudication systems, particularly NCRx or similar platforms.
Leadership experience managing a team of analysts or quality assurance professionals.
Strong analytical and problem-solving skills with experience in root cause analysis and corrective action planning.
Ability to collaborate cross-functionally with internal teams and external clients.
Experience establishing and enforcing quality assurance standards, procedures, and audit methodologies.
Proficiency in developing training materials, job aids, and standard operating procedures.

Responsibilities

Lead and oversee a team of Quality Assurance Analysts, ensuring effective execution of benefit configuration testing, validation, and audit activities.
Ensure accurate and timely completion of complex quality assurance for new client implementations, benefit changes, and ongoing maintenance across all lines of business.
Establish and enforce quality assurance standards, procedures, and audit methodologies, ensuring compliance with internal requirements.
Provide oversight on root cause analysis, issue resolution, and corrective action planning, partnering with the Issue Management Team.
Collaborate cross-functionally to drive process improvement, automation, and scalable initiatives to enhance efficiency and reduce risk.
Oversee development and maintenance of training materials, job aids, and standard operating procedures, ensuring consistency across the team.
Support and lead client interactions related to quality assurance and benefit configuration.