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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.
Work Schedule:
When working remotely, you will have the option to work a compressed schedule with 10-hour days Monday – Thursday with Friday off
When field-based or travelling, shift will be 8 hours Monday – Friday between 8am – 5pm EST
This position requires travel (via car, plane, and train) within a specific demographic. Travel requirement can be up to 75% of the calendar year.
You'll have the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectives
Perform onsite and desktop pharmacy network audits to identify potential discrepant pharmacy claims
Assess pharmacy site’s physical premises, compliance with regulatory requirements, and completeness of records
Gather and review documentation up to but not including prescription hardcopies, signature logs, compounding records, and MARs
Facilitate answers to questions from pharmacy network providers on a rotational basis
Report findings to pharmacy network providers
Reviews and assesses quality and accuracy of audits conducted (QC)
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:
High School Diploma/GED (or higher)
Current and unrestricted Pharmacy Technician license in the state of residence
Currently certified by the PTCB (Pharmacy Technician Certification Board) or ExCPT
2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment
2+ years of experience in a position processing pharmacy or medical claims
2+ years of experience with in-depth knowledge of pharmacy operations
2+ years of experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and have the ability to successfully investigate complex issues
1+ years of experience leading in-person and virtual/desktop audits
Basic level of proficiency with Microsoft Office (Word - creating and editing documents, Excel – creating, filtering, and maintaining spreadsheets)
Valid driver’s license and the ability to travel (car, train, plane) up to 75% of the year
Reside within a reasonable distance of an international airport
Preferred Qualifications:
Bachelor’s Degree
Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial health insurance)
Proficient in RxClaim or other pharmacy claims processing systems
Certified Quality Auditor (CQA)
Ability to problem solve including multiple priorities and research conflicting and/or inaccurate information
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii or Washington Residents Only : The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, or Washington residents is $48,300 to $94,500 per year. 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.
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