Senior Pharmacy Audit Representative

Description - External

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.

Schedule: Monday - Friday, 8:00am - 4:30pm PST (with a 30-minute lunch)

If you are located in the PST, CST, EST or MST Time Zone, you will enjoy the flexibility to telecommute* as you take on some tough challenges.  

Primary Responsibilities:

• Review and analyze pharmacy claims data, applying knowledge of pharmacy policy and practice and data mining techniques to determine details of potential wasteful, erroneous, or abusive billing activity using the Real Time Application System and various reports
• Senior Pharmacy Audit Representative will outreach to pharmacies, mostly telephonically, to verify pharmacy billing and have pharmacies correct claims if applicable 
• Senior Pharmacy Audit Representative will use in-depth knowledge of pharmacy operations, drug calculations, and pharmaceutical drug resources to evaluate if pharmacy claims are billed correctly
• Achieve assigned client goals and expectations
• Collaborate with fellow auditors to complete assigned work and recovery targets

What are the reasons to consider working for UnitedHealth Group?   Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• 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.)

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.

Qualifications - External

Required Qualifications:

• High School Diploma/GED (or higher)  
• Active and unrestricted Pharmacy Technician License in state of residence
• Active and unrestricted National Pharmacy Technician Certification (ExCPT or PTCB)
• 2+ years of experience as a Pharmacy Technician in a retail pharmacy, PBM or specialized pharmacy
• 2+ years of experience in Microsoft Word (creating/updating documents) and Microsoft Excel (creating/updating spreadsheets, pivot tables, and formulas)
• Flexibility to work as late as 5:00 PM Pacific Time
• Reside in the United States in the Central, Mountain, Pacific or Eastern Time Zone  

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

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