Integrity Auditor (Pharmacy Call Center)

IQVIA SOLUTIONS OPERATIONS CENTER PHILIPPINES, INC.; Manila; On-site; PHP 380,000 - 540,000; Full time

Job summary

IQVIA Solutions Operations Center Philippines, Inc. is seeking a Pharmacy Integrity Auditor to review pharmacy audit requests, conduct claims audits, and collaborate with pharmacy facilities to ensure compliance with program rules.

The role requires auditing experience, strong problem solving and communication skills, and the ability to manage multiple tasks with tight deadlines. Onsite work in Taguig with flexible schedules is expected.

Qualifications

• High School diploma or equivalent.
• Auditing experience in a customer care environment of at least 2 years.
• Excellent problem solving, telephone and communication skills.
• Good customer relationship skills.
• Ability to exercise independent judgment, appropriate discretion, and escalates to management as appropriate.
• Ability to rapidly adapt to new technologies and assess their potential impact and usefulness in diverse areas within the company.
• Ability to work flexibly with the team to ensure timely delivery of service.
• Ability to produce high quality work under pressure and within tight timescales.
• An ability to work within tight deadlines and manage time effectively.
• Strong team player with flexible attitude to work priorities.
• Excellent computer skills (MS Office applications).
• Amenable to reporting in flexible, shifting schedules and onsite in Taguig

Responsibilities

• Conduct pharmacy claims audits at the request of operations and management teams.
• Collaborate with pharmacy facilities to review documentation for compliance of claims.
• Exercise independent judgment to determine corrective actions for noncompliant claims and notify pharmacies.
• Document all details pertaining to claims audits and provide a summary to management.
• Provide interpretation and consultation to project teams on guidelines and SOPs.
• Evaluate applicable regulations and SOPs to assist with planning and reporting internal audit activities.
• Self-starter who can work with minimal supervision.
• Capable of recognizing operational challenges and designing solutions with the team.
• Handle multiple tasks with deadlines while prioritizing urgent requests.

Skills

Auditing experience

Problem solving

Communication skills

Customer relationships

Independent judgment

Adaptability to technology

Team flexibility

Working under pressure

Time management

MS Office

Onsite in Taguig

Education

High School diploma or equivalent

Job description

Pharmacy Integrity Auditor

Job Description Summary

Role Responsibilities

This individual will report to the program integrity Associate Manager and act as a shared resource in collaboration with various program teams to review both chain and independent pharmacy audit requests.

Principal Accountabilities

• Responsible for conducting pharmacy claims audits at the request of operations and management teams. May leverage health care providers, medical facilities, various billing portals, and contracting teams, as necessary.
• Responsible for collaboration with pharmacy facilities to acquire and review documentation necessary for assessing and validating compliance of claims against program business rules.
• Exercise independent judgment to determine appropriate corrective action of noncompliant claims, notify pharmacies of findings, and provide instructions on the appropriate corrective action. This can include potential reversal, refund, or reprocessing of claims.
• Document all details pertaining to claims audits and provide a summary to appropriate management team members.
• Provide interpretation and consultation to project teams on project specific guidelines/instructions and policies and procedures.
• Evaluate applicable regulations/guidelines, customer requirements, Standard Operating Procedures (SOPs) and project specific guidelines/instructions to assist with planning, scheduling, conducting, reporting and closing internal audit activities, as time permits.
• Self-starter able to carry out job responsibilities with minimal supervision.
• Possess exceptional organizational skills.
• Capable of recognizing operational challenges and collaborating with team to design solutions.
• Requires the ability to handle multiple simultaneous tasks with various deadlines while prioritizing urgent requests.

Required Skills

• High School diploma or equivalent
• Previous auditing experience working in a customer care environment of at least 2 years
• Excellent problem solving, telephone and communication skills
• Good customer relationship skills
• Ability to exercise independent judgment, appropriate discretion, and escalates to management as appropriate.
• Ability to rapidly adapt to new technologies and assess their potential impact and usefulness in diverse areas within the company
• Ability to work flexibly with the team to ensure timely delivery of service
• Ability to produce high quality work under pressure and within tight timescales
• An ability to work within tight deadlines and manage time effectively.
• Strong team player with flexible attitude to work priorities.
• Excellent computer skills (MS Office applications)
• Amenable to reporting in flexible, shifting schedules and onsite in Taguig

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.