Remote Pharmacy Audit Analyst - Overpayment Investigator

UnitedHealth Group; Minnetonka (MN); Remote; USD 50,000 - 89,000; Full time

Benefits offered by this job

Medical Plan Options

Dental & Vision Insurance

401(k) Savings Plan

Education Reimbursement

Paid Time Off & Holidays

Employee Discounts

Employee Referral Bonus

Voluntary Benefits

Job summary

UnitedHealth Group is seeking a Pharmacy Technician auditor to identify and document fraudulent or erroneous activities discovered during audits. The role involves preparing audit reports, determining overpayments, and coordinating remediation with Claims Administration.

The candidate should have active pharmacy license, PTCB certification, with 2+ years in pharmacy audit or related fields. The position supports a telecommuting arrangement within the United States, with standard 8-hour

Qualifications

• Active and unrestricted Pharmacy Technician license in the state of residence.
• Active National Certification by the PTCB (Pharmacy Technician Certification Board).
• 2+ years of experience in pharmacy audit, PBM, healthcare investigations, or health insurance environment.
• 2+ years of experience in a position processing/auditing pharmacy claims.
• Intermediate level of proficiency with Microsoft Excel.
• Ability to work an 8-hour shift, Monday - Friday, PST hours.
• Must be 18 years of age or older.

Responsibilities

• Identify and document fraudulent or erroneous activities determined as a result of an audit.
• Prepare audit reports and determine overpayments.
• Amends audit reports and determines overpayments.
• Collaborates with Claims Administration in the reverse and re-billing of overpaid claims.
• Coordinate timely closure of audits.
• Review and analyze claims data using pharmacy policy and data mining techniques to determine overpayment details.
• Monitor and report compliance issues with regulatory requirements.

Skills

Pharmacy License

PTCB Certification

Pharmacy Audit Experience

Data Analysis

Excel Proficiency

Shift Availability

Telecommute Ready

Job description

UnitedHealth Group is seeking a Pharmacy Technician auditor to identify and document fraudulent or erroneous activities discovered during audits. The role involves preparing audit reports, determining overpayments, and coordinating remediation with Claims Administration.

The candidate should have active pharmacy license, PTCB certification, with 2+ years in pharmacy audit or related fields. The position supports a telecommuting arrangement within the United States, with standard 8-hour