Pharmacy Audit Analyst

UnitedHealth Group • Irvine, CA

277d • $49,300 - $96,400 • Remote

About The Position

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 will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

• Current and unrestricted Pharmacy Technician License for the state of residence
• Currently certified by the PTCB (Pharmacy Technician Certification Board)
• 2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment
• 2+ years of experience in a position processing/auditing pharmacy claim
• Intermediate level of proficiency with Microsoft Excel
• Ability to work an 8-hour shift, Mondays - Fridays, between the hours of 6 am-5 pm PST
• Must be 18 years of age or older

Nice To Haves

• In-depth knowledge of pharmacy operations

Responsibilities

• Identify and document fraudulent or erroneous activities determined because 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
• Coordination of timely closure of audits
• Reviews and analyzes claims data, applying knowledge of pharmacy policy / practice and data mining techniques to determine details of overpayment billing activity while assisting with oversight of various audit programs
• Monitors and reports accordingly any compliance issues with regulatory requirement

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed