Pharmacy Quality Related Event Analyst, Customer Claims – Risk Mgmt

Location: Lakeland, FL
Job ID: 31050BR
Department: Risk Management
Working Hours: 9:00am - 5:30pm; Monday - Friday
Pay Frequency: Weekly
Date Posted: Dec 16, 2024

Salary varies

Hybrid

Full Time - Regular

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Description

This position performs the pharmacy quality related events (QRE) intake function, investigates all reported QRE’s, completes data entry of all QRE’s designated as a level one event into the Risk Master claims system. Primary duties include:

• Retrieving all reported QRE’s on a daily basis by exercising good independent judgement in assessing the appropriate course of action, maintaining accurate records of all QRE’s, and ensuring monthly deadlines are met,
• Investigating all reported QRE’s by establishing and maintaining courteous and professional relationships with retail pharmacy operations associates, accurately assessing information to facilitate early identification of high severity and exposure events, and determining if an event should be escalated to a Customer Claims Unit (CCU) adjuster,
• Data entry of all QRE’s into the Risk Master claims system and editing existing information in the Risk Master claims system and QRE database, and
• Referring asserted pharmacy claims to CCU adjusters by early identification of high severity or exposure events, preparing a narrative report, and gathering necessary documents necessary to accurately assess the claim.

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Required Qualifications

• computer skills including software utilized by Publix, including Risk Master claims system,
• data entry and typing skills (40 wpm),
• ability to manage highly confidential and sensitive information,
• excellent verbal and written communications skills,
• excellent investigative skills,
• excellent time management skills,
• high degree of maturity, discretion, tact, and independent judgement,
• professional telephone etiquette,
• good analytical skills,
• excellent organizational skills,
• good problem solving skills,
• good decision making skills,
• ability to multi-task,
• ability to adjust to a fluctuating work environment while maintaining a solid work ethic,
• general knowledge of office practices and procedures,
• good human relation skills (ability to work well with others and be a team member),
• high school diploma or equivalent, and
• 1 year of customer service, retail, or pharmacy operations experience.

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Preferred Qualifications

• Associate’s degree in any discipline,
• 2 years of customer service experience, or
• 2 years of retail operations experience, or
• 2 years pharmacy operations experience, or
• 1 year of Publix retail experience, and/or
• Second language, preferably Spanish – fluent.

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Benefits

• Employee stock ownership plan that contributes Publix stock to associates each year at no cost
• An opportunity to purchase additional shares of our privately-held stock
• 401(k) retirement savings plan
• Group health, dental and vision plans
• Paid Time Off
• Paid Parental Leave
• Short- and long-term disability insurance
• Tuition reimbursement
• Free hot lunches (buffet-style) at facilities with a cafeteria
• Visit our website to see all of our benefits: Benefits – Jobs (publix.com)

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Year End Bonus

To reward associates for their contributions to the company for the calendar year, Publix provides a Holiday Bonus in November. In the first year of continuous employment the bonus is equal to 15 hours of pay, and in the second year of continuous employment the bonus is equal to one week’s pay if associate remains employed through issue date of the bonus check. In subsequent years, the bonus is equal to two weeks’ pay.

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Additional Information

Your application may have additional steps that you will need to complete in order to remain eligible for consideration. Please be sure to monitor your email, including your spam folder, on a daily basis for critical, time-sensitive emails that could require action within 24-48 hours.

Please do not use your Publix email address when applying. Once your application has been successfully submitted you will receive a confirmation email.

Please note that Publix will not sponsor any hire for this position for a visa or permanent residence.

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