Pharmacy Claims Auditor: Compliance & Audit Specialist

HCM Nexus; Cebu City; On-site; PHP 400,000 - 560,000; Full time

Job summary

Nexus Recruitment Group is seeking a Pharmacy Claims Auditor to safeguard our claims data, conduct desk and on-site audits, and ensure compliance with regulations. You\'ll review billing, identify errors or potential fraud, and communicate with pharmacies to resolve issues.

Bachelor\'s degree in Pharmacy and 1 year of experience required; proficiency in MS Office; SQL/SAS knowledge a plus; strong analytical and communication skills.

Qualifications

• Bachelor's degree in Pharmacy with 1 year of pharmacy experience (Long Term Care, Specialty, or Mail Order a plus).

Responsibilities

• Conduct desk and on-site pharmacy audits.
• Review claims for errors, discrepancies, or fraud.
• Communicate with pharmacies to resolve billing issues.
• Prepare audit reports and recommend corrective actions.
• Document findings and ensure client invoicing accuracy.

Skills

Analytical skills

Problem-solving

Communication skills

Education

Bachelor's degree in Pharmacy

Tools

SQL/SAS knowledge

Job description

About the job Pharmacy Claims Coordinator

We're looking for a Pharmacy Claims Auditor to safeguard our claims data and prevent fraud. You'll conduct audits, analyze billing activities, and ensure compliance with regulations.

What Youll Do:

• Conduct desk and on-site pharmacy audits.
• Review claims for errors, discrepancies, or fraud.
• Communicate with pharmacies to resolve billing issues.
• Prepare audit reports and recommend corrective actions.
• Document findings and ensure client invoicing accuracy.

What You'll Bring:

• Bachelor's degree + 1 year pharmacy experience (Long Term Care, Specialty, or Mail Order a plus).
• Strong knowledge of pharmacy practice, laws, and regulations.
• Proficient in MS Office; SQL/SAS knowledge a plus.
• Excellent analytical, problem-solving, and communication skills.