Remote Pharmacy Audit Analyst - Data-Driven Compliance

Optum; Minnetonka (MN); On-site; USD 50,000 - 89,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan

Dental, Vision, Life & AD&D

401(k) Savings

Education Reimbursement

Employee Discounts

Employee Assistance Program

Remote work option

Job summary

Optum is hiring for a Pharmacy Audit Technician role with a focus on identifying fraud and overpayments in pharmacy claims. The position supports audit programs and regulatory compliance, with opportunity to work remotely within the United States.

The role requires a valid Pharmacy Technician license in your state, PTCB certification, and 2+ years in relevant audits or processing. Excel skills are required and shifts run Mon-Fri, 6am-5pm PST.

Qualifications

• Active, unrestricted Pharmacy Technician license in your state of residence.
• PTCB certification is required.
• 2+ years in pharmacy audit, PBM, healthcare investigations, or health insurance environment.
• 2+ years processing/auditing pharmacy claims.
• Intermediate Microsoft Excel skills.
• Able to work 8-hour shifts Mon-Fri, 6am-5pm PST.
• Must be 18 years of age or older.

Responsibilities

• Identify and document fraudulent or erroneous activities from audits.
• Prepare audit reports and determine overpayments.
• Amend audit reports and adjust overpayments.
• Collaborate with Claims Administration on reverse and re-billing of overpayments.
• Coordinate timely closure of audits.
• Review and analyze claims data with pharmacy policy knowledge and data mining for overpayment details.
• Monitor and report compliance issues with regulatory requirements.

Skills

Pharmacy audit

PBM experience

Healthcare investigations

Health insurance workflow

Excel proficiency

Shift availability

Education

PTCB Certification

Pharmacy Technician license (state)

Job description

Optum is hiring for a Pharmacy Audit Technician role with a focus on identifying fraud and overpayments in pharmacy claims. The position supports audit programs and regulatory compliance, with opportunity to work remotely within the United States.

The role requires a valid Pharmacy Technician license in your state, PTCB certification, and 2+ years in relevant audits or processing. Excel skills are required and shifts run Mon-Fri, 6am-5pm PST.