Remote Pharmacy Audit Analyst | Heavy Travel

UnitedHealth Group; Irvine (CA); Remote; USD 50,000 - 89,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a Pharmacy Auditor to perform pre-audit planning, travel, and both onsite and desktop audits within the U.S. The role emphasizes regulatory compliance, claims review, and collaboration with pharmacy network providers.

Requirements include 2+ years in pharmacy audit, a valid Pharmacy Technician license, and PTCB certification. Travel up to 75% is required; telecommuting is possible within the U.S.

Qualifications

• 2+ years in pharmacy audit, PBM, or health insurance investigations.
• 2+ years processing pharmacy or medical claims independently.
• Familiar with regulatory requirements and audit processes.

Responsibilities

• Complete pre-audit work including travel planning and desk audit activities.
• Conduct onsite and desktop audits to identify discrepant pharmacy claims.
• Assess sites for regulatory compliance and record completeness.
• Gather and review documentation up to but not including prescription copies.
• Answer questions from pharmacy network providers and report findings.
• Review the quality and accuracy of audits performed (QC).

Skills

Pharmacy audit

PTCB certification

Pharmacy Technician License

Microsoft Word

Microsoft Excel

Education

Bachelor's Degree

Tools

RxClaim

Job description

UnitedHealth Group is seeking a Pharmacy Auditor to perform pre-audit planning, travel, and both onsite and desktop audits within the U.S. The role emphasizes regulatory compliance, claims review, and collaboration with pharmacy network providers.

Requirements include 2+ years in pharmacy audit, a valid Pharmacy Technician license, and PTCB certification. Travel up to 75% is required; telecommuting is possible within the U.S.