Remote Pharmacy Claims Audit Lead

Gainwell Technologies; Missouri; Remote; USD 47,000 - 68,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) employer match

Flexible vacation policy

Educational assistance

Leadership and technical development

Job summary

Gainwell Technologies is seeking a Claims Audit Supervisor to lead drug claims auditing and adjudication within PBM services. The role emphasizes accurate adjudication, Medicaid compliance, and strong operational performance for a high-volume environment.

The position requires 5+ years in PBM/pharmacy operations and 2+ years in leadership, with a focus on collaboration with clients and internal teams. This is a remote, full-time role with competitive benefits.

Qualifications

• Must hold an active Pharmacy Technician certification (CPhT).
• 5+ years of PBM, pharmacy operations, drug claims processing and audit operations experience.
• 2+ years of leadership or supervisory experience.

Responsibilities

• Lead and supervise a team responsible for drug claims auditing and adjudication activities.
• Oversee claim audit workflows to ensure accuracy, timeliness, and compliance with PBM and Medicaid guidelines.
• Monitor performance metrics and drive process improvements to identify discrepancies.
• Manage escalations and resolve complex claims issues involving members, providers, and pharmacies.
• Collaborate with internal teams to support system updates, audits, and ongoing claims operations.
• Work with the state to present audit findings and manage appeal processes.

Skills

Leadership

Pharmacy operations

Drug claims processing

Audit operations

Client communications

Process improvement

Regulatory compliance

Education

Pharmacy Technician Certification (CPhT)

Tools

PBM software

Audit management tools

Job description

Gainwell Technologies is seeking a Claims Audit Supervisor to lead drug claims auditing and adjudication within PBM services. The role emphasizes accurate adjudication, Medicaid compliance, and strong operational performance for a high-volume environment.

The position requires 5+ years in PBM/pharmacy operations and 2+ years in leadership, with a focus on collaboration with clients and internal teams. This is a remote, full-time role with competitive benefits.