Quality & Process Improvement Specialist

BenecardPBF is seeking a QPI Specialist with cross-functional responsibilities that include reviewing documents for spelling, grammar, and accuracy. Reviewing member card ID packets, claims, clinical reviews, and other various aspects of the system on a day-to-day basis.

Please note: This role is 100% on-site, requiring in-office attendance five days per week with no remote or hybrid option.

Key Responsibilities

Quality Review & Analysis

• Complete quality reviews on documents, claims, member card ID packets, and clinical reviews.
• Perform detailed analysis and provide clear summary reporting on findings.
• Identify trends, gaps, and risks impacting quality and accuracy.

Reporting & Monitoring

• Develop, maintain, and enhance analysis and reporting tools.
• Utilize JIRA and COGNOS reporting software to run routine and ad hoc monitoring reports.
• Contribute to, monitor, and report on the success of key tactical quality strategies.

Process Improvement

• Identify and investigate quality issues with a focus on root cause analysis and proposed resolutions.
• Develop and maintain policies, desktop procedures, process flows, frameworks, and dashboards.
• Coordinate and support improvement efforts across departments.

Cross-Functional Collaboration

• Interact with all levels of management and staff across multiple departments.
• Facilitate regular meetings with business owners and management to review quality concerns.
• Provide additional resource support within the QPI department and to other operational areas as needed.

Project & Ad Hoc Support

• Complete special quality-related projects within short timeframes while maintaining a high level of accuracy.
• Perform other duties as assigned.

Qualifications:

• High School Diploma
• 1+ year of Quality Assurance or Quality Improvement experience is needed to be successful
• Strong knowledge of Microsoft Office Suite with a focus on Word and Excel
• Exceptional attention to detail with strong organizational skills.
• Professional written and verbal communication skills.
• Ability to clearly present data analysis results.
• Flexibility to work in high-pressure environments with tight deadlines.
• Strong interpersonal skills and cross-functional collaboration ability.
• Knowledge of Cognos Business Intelligence and JIRA software.
• Medical and/or pharmaceutical industry background would be preferred

Company Benefits:

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

About Benecard and 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:

BeneCard PBF

BeneCard 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 BeneCard 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