Supervisor, Claims Quality Testing

Navitus Health Solutions, LLC

1d•Remote

About The Position

Due to growth, we are adding a Supervisor, Claims Quality Testing to our team. The Supervisor, Claims Quality Testing oversees quality regression testing and pre-implementation audit processes, providing leadership and direction to a team of quality testing professionals. This role is responsible for ensuring testing activities are accurate, compliant, and aligned with business, client, and regulatory requirements. The Supervisor collaborates closely with internal and external partners to support effective issue resolution and drive continuous improvements in testing practices. This role requires strong management capabilities along with experience in benefit testing across PBM lines of business, preventative action planning, process improvements, and client-facing communication. Is this you? Find out more below!

Requirements

Bachelor’s degree or equivalent work experience is required.
3+ years leading a team responsible for quality or benefit testing specifically in a PBM environment.
Proven experience in leadership and team management.
Knowledge of regulatory requirements and industry standards applicable to PBM testing and quality activities.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

Provide leadership, oversight, and direction to a team of quality testing professionals supporting analysis and auditing processes.
Coach, mentor, and develop direct reports to ensure high performance, accountability, and professional growth.
Assign, prioritize, and manage quality testing workloads to meet project timelines and business objectives.
Oversee quality testing activities across PBM functions, including claims adjudication, eligibility, formulary, pricing, accumulators, and benefit configuration from a regression and/or pre-implementation audit perspective.
Ensure test plans, test cases, and execution are comprehensive, risk based, and aligned with business, client, and regulatory requirements.
Review and approve testing documentation and results to ensure accuracy, completeness, and consistency.
Oversee the identification, documentation, tracking, and resolution of discrepancies and quality issues identified during testing.
Partner with technology, configuration, operations, and business stakeholders to ensure timely and effective issue resolution.
Lead and support root cause analyses (RCA) for testing discrepancies, production issues, and quality trends.
Develop, implement, and monitor corrective and preventative action plans to reduce repeat issues.
Communicate testing outcomes, quality findings, and risk assessments to internal stakeholders and client facing teams.
Escalate critical or high-risk testing issues in accordance with established governance and reporting protocols.
Other duties as assigned.