Quality and Process Improvement Specialist

Under the direction of the QPI Manager, the Quality and Process Improvement (QPI) Specialist will have cross-functional responsibilities that include reviewing documents for spelling, grammar, and accuracy. Reviewing member card , claims, clinical reviews, and other various aspects of the system on a day-to-day basis.

Please note:

This role is fully on-site and requires in-office presence five days per week in Bonita Springs, Florida.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Completing quality reviews on documents, claims, and clinical reviews
• Ability to interact with all levels of management and departments
• Detailed analysis and summary reporting
• Utilize COGNOS reporting software to query routine and ad hoc monitoring reports
• Facilitate regular meetings with staff of various departments to identify quality concerns and coordinate improvement efforts
• Identify and investigate issues with a focus on root cause analysis and proposed resolutions
• Complete special quality-related projects in short time frames with a high level of accuracy
• Provide additional resource support to all areas within the QPI department and may also provide resource support to other operational areas as needed
• Other duties as assigned

QUALIFICATIONS:

• High School Diploma or equivalent is required
• Excellent Microsoft Office Suite skills are required
• Proficiency presentation of data analyses
• Knowledge of Cognos Business software is preferred, but not required
• Medical and/or pharmaceutical background is highly desirable
• Prior Quality Assurance background is highly desired
• Must have exceptional interpersonal and organizational skills
• Must be detail-oriented
• Must have professional written and verbal communication skills
• Must demonstrate flexibility and ability to work in high pressure situations and conform to tight deadlines

Featured Benefits

• Vacation and Sick/Personal Time
• Medical Insurance
• Hearing Program Discount
• Short- & Long-Term Disability Insurance
• Life Insurance
• Flexible Spending Account
• 401(k)
• Employee Referral Program
• Employee Recognition
• Tuition Reimbursement
• Professional Development Training

About Benecard Services our affiliated companies:

Benecard Services, LLC

Benecard Services, LLC has been administering carve-out, fixed rate insured prescription drug benefit programs since 1990. Benecard is a full service, in-house prescription benefit administrator that includes mail and specialty drug dispensing. We are a premiere nationwide Prescription Benefit Administrator headquartered in Lawrenceville, New Jersey.

Website:

Bene Card PBF

Bene Card PBF provides self-funded prescription benefit program administration with a personalized approach through focused, clinical expertise. Our business model operates on a customized claim processing system offering unlimited capability and flexibility to respond to client needs in an evolving marketplace. Advanced clinical programs and advanced technology provide the framework to maximize the use of all data elements available. This allows Bene Card PBF to filter the information, focus on clinical opportunities and facilitate interaction between the physician, the pharmacist and the patient to effectively promote complete health care.

Headquartered in Bonita Springs, Florida.

Website:

National Vision Administrators

For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health & Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care.

We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.

Website:

We are an Equal Opportunity employer.

Monday - Friday 8:30am - 5:00pm