Alberta Blue Cross Quality Assurance and Claims Management Analyst – Pharmaceutical Services Full Time in Edmonton, AB

Overview

Alberta Blue Cross

Branch Edmonton AB CA

Position:
Quality Assurance and Claims Management Analyst – Pharmaceutical Services
Location:
Edmonton, AB

With the guidance of the Team Manager, Pharmacy Provider Agreement and Administration, this position is responsible for analyzing claim adjudication results to…

FUNCTION:
With the guidance of the Team Manager, Pharmacy Provider Agreement and Administration, this position is responsible for analyzing claim adjudication results to ensure claims are paid in accordance with drug benefit plan rules, and to report findings and make recommendations.

DUTIES AND RESPONSIBILITIES:
Using reporting tools, measures claim quality against established performance standards, identifying patterns, common errors and system issues. Based on findings, recommend procedural changes to ensure these performance standards are met.

Perform additional quality assurance checks on claim adjudication results arising from the implementation of departmental initiatives and/or plan design changes.

Create patient/prescriber/pharmacy profiles, and other standard reporting for internal and external clients .

Complete quality assurance on selected government program claims .

Work with pharmacies to adjust claims to ensure claim quality.

SKILLS AND KNOWLEDGE:
A comprehensive knowledge of the industry, POS and drug plan design is an asset.

Must be analytical and able to use good judgment in evaluating and decision-making, and provide recommendations based on findings.

Strong problem solving abilities are a must.

Excellent organizational and time management skills with the ability to complete multiple projects.

Self directed with a strong sense of accountability.

Demonstrated ability to contribute within a team environment.

Demonstrated proficiency in Microsoft Word and Excel a must. Proficiency with Microsoft Access is a definite asset.

Demonstrated willingness and ability to adapt to changing priorities.

This position will remain open until a suitable candidate is found. If you have the qualifications we are looking for, apply online at www.ab.bluecross.ca .