Pharmacy Quality Related Event Analyst, Customer Claims - Risk Mgmt
Publix
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, andreferring 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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