Remote Senior Pharmacy Claims Audit Lead

Prime Therapeutics; Salem (OR); Remote; USD 59,000 - 94,000; Full time

Job summary

Prime Therapeutics is seeking a Senior Pharmacy Claims Auditor to lead audit education, tools, analytics and training, ensuring compliant reimbursements and reducing waste. The role collaborates with cross-functional teams, analyzes claim data, supports audit initiatives, and serves as SME for system enhancements.

The position offers a remote work arrangement with an Oregon location preference, and requires a Bachelor’s in Health Science or related field, 5 years in pharmacy/PBM, and PTCB/ExCPT

Qualifications

• Bachelor's degree in Health Science or related field, or equivalent combination of education and related work experience; HS diploma or GED is required.
• 5 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and PBM experience to include 3 years of audit or quality assurance.
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT).
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Responsibilities

• Collaborate with cross-functional teams to identify, develop, deliver, and support training focused on trend analysis, audit planning, procedures, and system process, along with identifying technology enhancement opportunities.
• Provide guidance and operational support to the Pharmacy Audit Operations team, promoting best practices, leading projects, and resolving issues.
• Analyze claim and audit data to support ongoing audit analytic efforts, identify trends and refinements; collaborate with other department staff to create enhanced reporting and represent audit team as the SME for system enhancement initiatives and testing.
• Other duties as assigned.

Skills

MS Word

Excel

Database software

Education

Bachelor's degree in Health Science or related

HS diploma or GED

Tools

PTCB/ExCPT (CPhT)

Job description

Prime Therapeutics is seeking a Senior Pharmacy Claims Auditor to lead audit education, tools, analytics and training, ensuring compliant reimbursements and reducing waste. The role collaborates with cross-functional teams, analyzes claim data, supports audit initiatives, and serves as SME for system enhancements.

The position offers a remote work arrangement with an Oregon location preference, and requires a Bachelor’s in Health Science or related field, 5 years in pharmacy/PBM, and PTCB/ExCPT