Senior Pharmacy Audit Representative - National Remote - Healthcare Compliance and Quality Assurance

Join the UnitedHealth Group Team as a Senior Pharmacy Audit Representative

Start your career journey with us! We have an exciting opportunity for a Senior Pharmacy Audit Representative - National Remote! This is a fully Remote role, offering you the flexibility to work from anywhere. As a Senior Pharmacy Audit Representative, you will play a critical role in analyzing and monitoring claims against potential fraud, waste, and abuse related to network pharmacies. If you have a strong and diverse skillset in relevant areas, we encourage you to apply for this challenging and rewarding position.

About UnitedHealth Group

UnitedHealth Group is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Key Responsibilities

• Analyze and monitor claims against potential fraud, waste, and abuse related to network pharmacies
• Investigate, review, and analyze claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of potential fraudulent, erroneous, or abusive billing activity on Real Time Application System and various reports
• Identify and document potential fraudulent or erroneous activities determined as a result of their work
• Collaborate with internal stakeholders to develop and implement effective audit strategies and processes
• Provide expert knowledge of pharmacy operations and policy to support audit activities
• Develop and maintain comprehensive knowledge of pharmacy benefits, claims processing, and regulatory requirements
• Stay up-to-date with industry trends, best practices, and regulatory changes to ensure compliance and quality assurance

Requirements and Qualifications

Essential Qualifications:

• High School Diploma/GED (or higher) OR 2 years of experience as a Pharmacy Technician in a retail pharmacy, PBM, or specialized pharmacy
• Active and unrestricted Pharmacy Technician License in the state of residence at the time of hire
• Active and unrestricted National Pharmacy Technician Certification (ExCPT or PTCB) at the time of hire
• 2 years of experience in Microsoft Word (creating/updating documents) and Microsoft Excel (creating/updating spreadsheets, pivot tables, and formulas)
• 1 year of Pharmacy Technician experience in a retail pharmacy, PBM, or specialized pharmacy
• Ability to work Tuesday – Saturday OR Monday – Friday PST, 4 shifts will be 9 hours with 1 shift 4 hours (with a 30-minute lunch); shift hours can start at different times (6am, 7am, 8am)
• Reside in the United States in the Central, Mountain, Pacific, or Eastern Time Zone
• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Preferred Qualifications:

• Bachelor's degree in a related field (e.g., pharmacy, healthcare administration)
• 3+ years of experience in pharmacy audit, compliance, or quality assurance
• Experience with data analysis and reporting tools (e.g., Excel, Access, SQL)
• Knowledge of pharmacy benefits, claims processing, and regulatory requirements
• Certification in pharmacy audit or compliance (e.g., CPAP, CCEP)

Skills and Competencies

• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong attention to detail and organizational skills
• Ability to adapt to changing priorities and deadlines
• Strong knowledge of pharmacy operations, policy, and regulatory requirements
• Experience with data analysis and reporting tools

Career Growth Opportunities and Learning Benefits

At UnitedHealth Group, we are committed to the growth and development of our employees. As a Senior Pharmacy Audit Representative, you will have access to:

• Comprehensive training and onboarding program
• Ongoing education and training opportunities
• Career development and advancement opportunities
• Competitive salary and benefits package

Work Environment and Company Culture

UnitedHealth Group is a diverse and inclusive organization that values its employees. As a remote employee, you will have the flexibility to work from anywhere and enjoy:

• Flexible work arrangements
• Opportunities for career growth and development
• Comprehensive benefits package
• Recognition and rewards for outstanding performance
• A culture guided by diversity, inclusion, and respect

Compensation, Perks, and Benefits

We offer a competitive salary and benefits package, including:

• Competitive base pay
• Comprehensive benefits package (medical, dental, vision, life insurance)
• 401(k) Savings Plan and Employee Stock Purchase Plan
• Paid Time Off and Paid Holidays
• Education Reimbursement and Employee Discounts
• Employee Assistance Program and Voluntary Benefits

How to Apply

If you are a motivated and detail-oriented individual with a passion for pharmacy audit and compliance, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to:

UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.