Client Services Business Quality Assurance Analyst II - Medicaid Fee For Service

MedImpact Healthcare Systems, Inc.•San Diego, CA

1d•$29 - $48•Onsite

About The Position

The Client Services Business Quality Assurance Analyst II – Medicaid FFS serves as a subject matter expert in benefit configuration and quality assurance across MedImpact’s PBM programs. This role leads complex validation efforts, oversees quality and compliance review activities, and ensures that configuration, operational processes, and deliverables meet client requirements and internal quality standards. Operating with a high degree of independence, this position drives continuous improvement, mentors analysts, and partners cross-functionally to enhance accuracy, efficiency, and compliance across the organization.

Requirements

BS/BA and 3+ years’ experience or equivalent combination of education and experience
Previous experience writing SQL queries, Automation Testing, File Transfer Protocol and UNIX is highly desirable.
Intermediate to advanced skills in Microsoft Office with an emphasis on Word, Excel, MS Access and Project.
Intermediate to advanced skills in SQL queries.
Knowledge of Quality Assurance methodologies and practical application.
Ability to research, assess, audit, and apply information to practices and standards.
Strong analytical and problem solving ability and in-depth understanding of PBM regulations and related CMS guidance
Demonstrated ability to work in a fast paced environment, learn quickly, appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
Demonstrate ability to meet or exceed the competencies as listed.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.

Nice To Haves

Healthcare, Managed Care, Government Programs or PBM Quality experience is preferred

Responsibilities

Lead the design, execution, and oversight of complex configuration validation activities for benefit, pharmacy network, and formulary administration in pre‑production environments.
Apply advanced Configuration Services best practices to develop comprehensive test plans, data sets, test scenarios, expected results, and acceptance criteria.
Validate configuration accuracy for maintenance of business, new client implementations, regulatory updates, and special projects.
Analyze claims adjudication results to identify discrepancies, anomalies, and unintended consequences; recommend and implement corrective actions to optimize configuration design.
Approve configuration design plans for complex or unique benefit requests and ensure accurate migration of validated changes from Test to Production environments.
Develop, refine, and execute quality assurance procedures to ensure operational compliance with PBM standards and client requirements.
Lead quality and compliance review projects, including test execution, documentation of results, and development of corrective action plans.
Participate in internal and external audits of PBM services, ensuring findings are addressed promptly and effectively.
Perform high‑volume data testing across multiple file types to validate accuracy, completeness, and regulatory compliance.
Serve as a senior liaison to internal operational teams and external clients to improve the quality and compliance of PBM program implementations and ongoing operations.
Respond to complex inquiries regarding quality review outcomes, compliance requirements, and configuration validation processes.
Communicate significant issues, risks, and improvement opportunities to leadership, ensuring visibility and timely resolution.
Champion continuous quality improvement initiatives by identifying process gaps, recommending enhancements, and supporting implementation of efficiency improvements.
Mentor and coach Testing & Validation Analysts and Quality Analysts, providing guidance on test design, analysis techniques, regulatory interpretation, and best practices.
Contribute to the evolution of departmental methodologies, tools, and documentation to strengthen organizational quality and validation capabilities.