Manager, Quality Assurance & Benefits Configuration

LucyRx • Bethesda, OH

18d • Remote

About The Position

The Quality Assurance (QA) Manager, Benefits Configuration will build, launch, and lead our QA program for benefits configuration within our Pharmacy Benefit Manager (PBM) organization. This is a highly visible, hands on leadership role responsible for establishing QA strategy, designing scalable processes, and ensuring the accuracy and integrity of benefit configurations that directly impact our clients, members, and downstream operational teams.

Requirements

• 5+ years of experience in PBM, health plan, or healthcare benefits administration, with at least 2 years in QA, configuration, or related functions.
• Strong understanding of pharmacy benefit design, formulary structures, accumulators, UM/PA logic, and claims processing.
• Proven experience building or enhancing QA programs, frameworks, or processes.
• Exceptional attention to detail and analytical skills.
• Ability to interpret complex benefit requirements and translate them into testable scenarios.
• Experience working cross‑functionally in a fast‑paced, deadline‑driven environment.
• Strong communication skills with the ability to influence and collaborate at all levels.
• Familiarity with PBM configuration platforms, claims systems, or adjudication engines.
• Demonstrated ability to lead high performing teams through change and drive operational excellence.

Nice To Haves

• Experience with SQL, test automation tools, or data validation techniques.
• Knowledge of regulatory requirements (CMS, ERISA, state mandates) impacting pharmacy benefits.

Responsibilities

• Design, launch, and continuously refine a comprehensive QA program for benefits configuration, including frameworks, workflows, documentation standards, and quality metrics.
• Establish QA methodologies, including test plans, test cases, regression testing, and validation protocols tailored to PBM benefit structures.
• Partner with cross‑functional teams—Configuration, Clinical, Operations, Client Services, and IT—to ensure alignment on quality standards and implementation timelines.
• Develop and maintain QA policies, SOPs, and best practices to support consistent, repeatable, and auditable processes.
• Serve as the primary point of contact for QA inquiries related to benefit configuration.
• Perform detailed QA reviews of benefit configurations, including formulary rules, accumulators, utilization management criteria, pricing logic, and network parameters.
• Validate configuration accuracy against client requirements, benefit designs, regulatory guidelines, and internal standards.
• Conduct root‑cause analysis for defects and partner with configuration teams to drive timely resolution.
• Build and maintain test data, scenarios, and tools to support ongoing QA activities.
• Monitor and track defect trends, identifying opportunities for process improvement and automation.
• Act as a working manager—balancing leadership responsibilities with hands‑on QA work.
• Hire, mentor, and develop a high‑performing QA team as the program scales.
• Foster a culture of accountability, continuous improvement, and operational excellence.
• Provide training and guidance to internal teams on QA processes, benefit interpretation, and configuration quality expectations.
• Define and track KPIs related to configuration accuracy, defect rates, and audit outcomes.
• Deliver clear, actionable reporting to leadership and stakeholders.
• Recommend and implement improvements based on data insights and industry best practices.

Benefits

• Competitive salary
• Meaningful change
• Supportive culture
• Opportunity to grow

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed