Consultant, Issue Management

Issue Management Consultant

Due to growth, we are adding an Issue Management Consultant to our CAO Quality department. The Issue Management Consultant plays a critical role in identifying, analyzing, and resolving claim adjudication issues to ensure accuracy, compliance, and operational efficiency. This position focuses heavily on claims reprocessing, risk mitigation, and requirement documentation, serving as a key liaison between internal business units and external clients.

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Responsibilities

Investigate issues to identify underlying root causes. Apply RCA methodologies such as the 5 Whys to uncover systemic problems. Document findings and produce comprehensive RCA reports. Develop and implement action plans to prevent recurrence of issues. Monitor the effectiveness of preventative actions and adjust as needed. Integrate preventative strategies into broader quality improvement initiatives. Maintain detailed records of issues, actions taken, and outcomes. Provide oversight of remediation efforts to ensure completeness and accuracy. Manage end-to-end issue tracking and testing to validate resolution. Identify opportunities for process improvement based on RCA findings. Collaborate with internal teams to refine RCA and preventative action methodologies. Write clear, actionable business requirements to support issue resolution and system enhancements. Apply knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards, to ensure accuracy and compliance Other duties as assigned

Qualifications

Bachelor's degree or equivalent work experience required 2+ years of experience required in root cause analysis, issue management, and preventative action planning within the PBM or healthcare industry Experience with RCA tools and methodologies Demonstrated knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards is required Proficiency in Microsoft Office Suite Knowledge of regulatory requirements and industry standards in PBM Participate in, adhere to, and support compliance program objectives The ability to consistently interact cooperatively and respectfully with other employees

Top of the industry benefits for Health, Dental, and Vision insurance 20 days paid time off 4 weeks paid parental leave 9 paid holidays 401K company match of up to 5% - No vesting requirement Adoption Assistance Program Flexible Spending Account Educational Assistance Plan and Professional Membership assistance Referral Bonus Program up to $750!

Remote US