At EVERSANA, we are proud to be certified as a Great Place to Work across the globe. We’re fueled by our vision to create a healthier world. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us! 

Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs.  We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve.   We are EVERSANA.  

THE POSITION:

The Analyst, QA & Pharmacy Fraud is primarily responsible for the quality assurance and analysis of patient affordability programs, specifically for the pre- and post-implementation of pharmaceutical or medical device coupons, vouchers, and copay card programs utilized in a pharmacy or medical setting. This role provides auditing against program expectations and parameters outlined by business rule documents, contracts, program operations leaders, and clients as well as state and federal laws.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by

• Analyzes and communicates findings in monthly dashboard of daily, weekly, and monthly analysis of business rule violations and pharmacy fraud detections
• Works with third-party administrators to initiate pharmacy audits and follows through to completion within timeframes outlined in service level agreements
• Creates and reviews test case scenarios to ensure accuracy prior to go live and continues post-go live in accordance with SOP’s
• Analyzes Data trends and SLAs and provides insight both internally and to clients
• Partner with clients to act on Data trends and insights
• Develops collaborative relationships across EVERSANA departments, client teams and agency partners to accomplish client goals, program rollouts, and enhancements
• Monitors program operations to ensure adherence to business rules, contract commitments, and quality expectations
• Uses pharmacy, beneficiary, and various health care data and analytic tools to assemble, prepare, and analyze information in support of policy and business decision making
• Develops report criteria to monitor changes and business rules of programs
• Creates and adheres to quality standards and follows all SOWs, SOPs, and other requirements
• Collaborates with Client Engagement Partners to support and participate as needed in quarterly business reviews
• Identifies and assists in resolution of data issues, escalating timely to management and/or client to expedite resolution
• Contributes to team and self-development through ongoing process improvement initiatives, knowledge sharing, and quality reviews.
• Identifies and influences systemic changes to improve data deliverables and outcomes, quality, and services.
• Translates business questions into data requests and subsequently translates data into actionable information
• All other duties as assigned

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

EXPECTATIONS OF THE JOB:

• Maintain strict confidentiality for all account activity.
• Respond promptly to customer needs and solicits client feedback to improve service.
• Foster ethical and responsible decision making as a proactive client advocate and EVERSANA representative.
• Assist in the development and implementation of enterprise growth through strong internal company relationships.
• Ensure the accurate, complete, and appropriate disclosure of clientele information.

The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position.

An individual in this position must be able to successfully perform the expectations listed above.

MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES:

The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.

• Bachelor’s degree
• 3 years related experience
• Knowledge/experience with Microsoft Office Suite
• Able to perform detail-oriented work
• Able to analyze data and trends and draw conclusions
• Able to work in a fast-paced environment and handle multiple projects at once
• Proven, excellent verbal and written communication and presentation skills

PREFERRED QUALIFICATIONS:

• Experience in quality assurance, auditing, pharmacy benefits administration
• Experience working with pharmacy data in a pharmacy setting
• Familiarity with pharmacy claims data
• Experience with manufacturer affordability programs, including co-pay and voucher programs

OUR CULTURAL BELIEFS:

Patient Minded I act with the patient’s best interest in mind.

Client Delight I own every client experience and its impact on results.

Take Action I am empowered and empower others to act now.

Grow Talent I own my development and invest in the development of others. 

Win Together I passionately connect with anyone, anywhere, anytime to achieve results.

Communication Matters I speak up to create transparent, thoughtful and timely dialogue.

Embrace Diversity I create an environment of awareness and respect.

Always Innovate I am bold and creative in everything I do.

PHYSICAL/MENTAL DEMANDS AND WORKING ENVIRONMENT:

The physical and mental requirements along with the work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position.

This is a largely sedentary role. While performing the essential functions of this job, the employee is regularly required to stand and/or sit for long period of time (up to 90%). Additionally, this role is regularly required to talk, hear, type, and engage in repetitive motion, reach and grasp; occasionally required to lift and/or move up to 25 pounds. The employee is intermittently required to stoop or crouch; push or pull; or kneel. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

This role requires mental alertness. The employee must regularly communicate both verbally and written; concentrate on tasks; and remember and observe details. The employee must frequently adjust to changes; shifting priorities, handle stress and emotions; think analytically; and be a problem-solver.

This job operates in a professional office environment. This role routinely uses standard office equipment.

The noise level in the work environment is usually moderate, with frequent interruptions and multiple demands.

All your information will be kept confidential according to EEO guidelines.

From EVERSANA’s inception, Diversity, Equity & Inclusion have always been key to our success. We are an Equal Opportunity Employer, and our employees are people with different strengths, experiences, and backgrounds who share a passion for improving the lives of patients and leading innovation within the healthcare industry. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion, and many other parts of one’s identity. All of our employees’ points of view are key to our success, and inclusion is everyone's responsibility.

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