Senior Pharmacy Audit Representative - National Remote

Optum; Irvine (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Pharmacy Audit Representative to join their dynamic team. In this role, you will leverage your expertise to analyze claims and identify potential fraud, ensuring integrity within the pharmacy network. With a strong emphasis on career development and a supportive culture, you'll enjoy the flexibility of remote work while contributing to meaningful health outcomes. This is an exciting opportunity to make a real impact in the healthcare sector while growing your professional skills in a collaborative environment.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• Current and unrestricted Pharmacy Technician license required.
• 2+ years of experience in a retail pharmacy environment.

Responsibilities

• Analyze and monitor claims for fraud, waste, and abuse.
• Investigate claims data using pharmacy policy knowledge.

Skills

Pharmacy Technician License

National Pharmacy Technician Certification

Microsoft Word

Microsoft Excel

Communication Skills

Education

High School Diploma or Equivalent

Tools

PARP Application

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Positions in this function analyze and monitor claims against potential fraud, waste and abuse related to network pharmacies


• Investigate, review and analyze claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of potentially fraudulent, erroneous, or abusive billing activity using the PARP Application System


• Senior Pharmacy Audit Representative will need to identify and document potentially fraudulent or erroneous activities determined because of their work


• Senior Pharmacy Audit Representative are licensed Pharmacy Technicians with in-depth knowledge of pharmacy operations


• Senior Pharmacy Audit Representative are responsible to achieve assigned goals and meet quality standards for their documentation

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current and unrestricted Pharmacy Technician license in state of residence


• Current and active National Pharmacy Technician Certification (ExCPT or PTCB)


• 2+ years of Pharmacy Technician experience in a retail pharmacy environment, specialized pharmacy or PBM


• 2+ years of experience with Microsoft Word (creating/updating documents) and Microsoft Excel (creating/updating spreadsheets, pivot tables, and formulas)


• Reside in the United States in the Central, Eastern, Mountain, or Pacific Time Zone


• Ability to work Monday- Friday between 6:00 AM and 5:00 PM PST


• Must be 18 years of age or older

Preferred Qualifications:

• Proven solid communication skills


• Experience with PARP application

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN