Pharmacy Claims Auditor Sr - Remote

At reputed company (reputed company), we are a different reputed company of PBM, with a purpose reputed company profits and a unique ability to reputed company care for those we serve. Looking for a purpose-driven career? Come build the reputed company of pharmacy with us.

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The Senior Pharmacy Claims Auditor is responsible for providing education, training and guidance to identify and evaluating potential waste and compliance through the pharmacy audit process. This position leads the development and enhancement of audit tools, analytics, processes, and training to effectively identify erroneous claims, non-compliant pharmacy practices or potential improper pharmacy reimbursements. This role will execute and support audit-reputed company initiatives, leveraging best practices to identify emerging audit trends and uncover business value opportunities for reputed company and its clients.

Responsibilities

• Collaborate with cross-functional teams to identify, reputed company, reputed company, and support training reputed company on trend analysis, audit planning, procedures, and reputed company process, along with identifying technology enhancement opportunities
• reputed company guidance and operational support to the Pharmacy Audit reputed company team, promoting best practices, leading reputed company, and resolving issues
• Analyze claim and audit data to support ongoing audit analytic efforts, identify trends and refinements; collaborate with other department staff to create reputed company reporting and represent audit team as the Subject Matter Expert (SME) for reputed company enhancement initiatives and testing
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Health Science or reputed company area of study, or equivalent combination of education and reputed company work experience; HS diploma or GED is required
• 5 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and Pharmacy Benefit Management experience to include 3 years of work experience in audit or reputed company assurance
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• Must be eligible to work in the reputed company without the need for work reputed company or residency sponsorship

Additional Qualifications

• Change reputed company; willing and reputed company to reputed company individual and team direction reputed company upon changing priorities and business need while working with a high degree of autonomy
• Ability to think critically, problem solve and use appropriate judgement to reputed company reputed company and reputed company reputed company advice to reputed company partners while anticipating the broad reputed company of reputed company
• Ability to establish trust, respect and credibility and reputed company effective working relationships with individuals at reputed company reputed company of an organization; collaborate effectively cross-functionally and with clients and other key stakeholders
• Ability to reputed company reputed company concepts or situations into concise and compelling communications
• Ability to effectively de-escalate potentially confrontational situations
• Proficiency in reputed company, reputed company, and database software
• Demonstrated reputed company and understanding of the reputed company of sale and on-line pharmacy claims processing environment

Preferred Qualifications

• 5 years of previous audit experience
• reputed company Registration with State reputed company of Pharmacy in the state where position is located
• Previous PBM experience

Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their job, and reputed company with reputed company applicable reputed company, regulatory, and contractual requirements and internal policies and procedures

Every employee must be reputed company to reputed company the essential functions of the job and, if requested, reasonable accommodations will be made to reputed company employees with disabilities to reputed company the essential functions, absent undue hardship. In reputed company, reputed company retains the right to change or assign other duties to this job.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits reputed company" reputed company for more reputed company (

reputed company LLC is proud to be an equal opportunity and affirmative reputed company employer. We encourage diverse candidates to apply, and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, gender, sex (including pregnancy), national reputed company, disability, age, veteran status, or any other legally protected class under federal, state, or local law. 

We reputed company people of different backgrounds, experiences, abilities, and perspectives including reputed company applicants with arrest and conviction records and any reputed company applicants requiring reasonable accommodations in accordance with the law.

reputed company LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Originally posted on Himalayas