About the Company
OptumRx, a UnitedHealth Group company, is a leading pharmacy benefit manager (PBM) dedicated to helping people live healthier lives. We simplify the pharmacy experience, making medications more affordable and accessible for millions of members. Our innovative solutions drive better health outcomes and manage pharmacy spend for clients across the nation.
Job Description
We are seeking a highly detail-oriented and accurate Pharmacy Auditing Clerk to join our remote team. In this critical role, you will be responsible for meticulously reviewing pharmacy claims, identifying discrepancies, and ensuring compliance with regulatory guidelines and company policies. This position requires exceptional focus and a commitment to data integrity, directly impacting our operational efficiency and member satisfaction.
Key Responsibilities
- Perform detailed audits of pharmacy claims data for accuracy, completeness, and adherence to established protocols.
- Identify and document claim errors, discrepancies, and potential fraud or abuse patterns.
- Utilize various internal systems and external databases to research and validate claim information.
- Prepare clear and concise reports on audit findings, including root cause analysis.
- Collaborate with internal teams (e.g., claims processing, customer service) to resolve identified issues.
- Maintain strict confidentiality of all protected health information (PHI) and sensitive data.
- Stay updated on changes in pharmacy regulations, industry standards, and company policies relevant to auditing.
- Assist in the development and refinement of auditing procedures and tools.
Required Skills
- Proven experience in a data entry, administrative, or auditing role, preferably within healthcare or pharmacy.
- Exceptional attention to detail and accuracy.
- Strong analytical and problem-solving skills.
- Proficiency with Microsoft Office Suite, particularly Excel.
- Excellent organizational and time management abilities.
- Ability to work independently in a remote environment with minimal supervision.
- Strong communication skills, both written and verbal.
Preferred Qualifications
- Associate's degree in a related field (e.g., Medical Billing, Health Information Management).
- Pharmacy Technician certification (CPhT).
- Familiarity with medical terminology and prescription drug names.
- Experience with pharmacy claims processing systems or PBM operations.
- Knowledge of HIPAA regulations and other healthcare compliance standards.
Perks & Benefits
- Comprehensive health, dental, and vision insurance.
- Paid time off and company holidays.
- 401(k) retirement plan with company match.
- Employee assistance program.
- Opportunities for professional development and career growth.
- Flexible remote work environment.
- Life and disability insurance.
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.
⚠️ Important Disclaimer
Welcome to Westford Trust. We publish job opportunities aggregated from public sources, employers, and job portals. We never charge any fees to access or use our website; all information is provided entirely for free.
Westford Trust does not directly offer or manage these positions, nor are we directly involved in the hiring process for the vacancies published on https://job.westfordtrust.com.
If you suspect a fraudulent listing or have any questions, please contact us at techturna@gmail.com.