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

About the role

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.

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.
• Aprove 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.
• 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.

Qualifications

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