About the Company
Optum, a part of UnitedHealth Group, is a leading health services innovation company dedicated to helping make the health system work better for everyone. We combine technology, data, and expertise to improve the delivery, quality, and efficiency of healthcare. Our mission is to help people live healthier lives and to help make the health system work better for everyone. We are committed to fostering an inclusive culture that values diversity, encourages collaboration, and supports professional growth.
Job Description
We are seeking a highly detail-oriented and analytical Pharmacy Auditing Clerk to join our remote team. This critical role involves meticulously reviewing pharmacy claims, identifying discrepancies, and ensuring compliance with established policies, procedures, and regulatory requirements. The ideal candidate will possess a sharp eye for detail, strong organizational skills, and a commitment to accuracy. This is a vital position that directly contributes to the integrity of our pharmacy claims processing and the financial health of our organization.
Key Responsibilities
- Perform comprehensive audits of pharmacy claims to ensure accuracy and compliance with plan benefits, contracts, and regulatory guidelines.
- Identify and document discrepancies, errors, or potential fraud, waste, and abuse.
- Collaborate with internal teams and external pharmacy providers to resolve identified issues.
- Maintain accurate and detailed records of all audit activities and findings.
- Prepare clear and concise reports summarizing audit results and recommendations.
- Stay updated on pharmacy regulations, industry best practices, and internal policy changes.
- Contribute to the continuous improvement of auditing processes and methodologies.
- Handle confidential information with the utmost discretion and integrity.
Required Skills
- Minimum 1 year of experience in pharmacy operations, claims processing, or auditing.
- Exceptional attention to detail and a high degree of accuracy.
- Strong analytical and problem-solving abilities.
- Proficiency with Microsoft Office Suite, especially Excel.
- Excellent written and verbal communication skills.
- Ability to work independently in a remote environment with minimal supervision.
- Strong organizational and time management skills.
Preferred Qualifications
- Associate's or Bachelor's degree in a relevant field (e.g., Healthcare Administration, Business, Finance).
- Certification as a Pharmacy Technician (CPhT).
- Experience with pharmacy benefit management (PBM) systems or claims auditing software.
- Familiarity with HIPAA regulations and other healthcare compliance standards.
Perks & Benefits
- Competitive salary and performance bonuses.
- Comprehensive health, dental, and vision insurance.
- 401(k) retirement plan with company match.
- Paid time off and company holidays.
- Employee assistance program.
- Opportunities for professional development and career advancement.
- Work-from-home stipend for essential equipment.
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
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