Pharmacy Claims Auditor Sr – Remote

About This Opportunity

We are representing a confidential pharmacy benefit management organization seeking a Senior Pharmacy Claims Auditor to join their remote team. This senior-level role focuses on identifying compliance issues, waste reduction, and process improvements through comprehensive pharmacy audit procedures. You'll serve as a subject matter expert, leading training initiatives and collaborating across departments to enhance audit analytics and tools.

Responsibilities

• Lead the development and enhancement of audit tools, analytics, processes, and training programs to identify erroneous claims and non-compliant pharmacy practices
• Collaborate with cross-functional teams to develop and deliver training on trend analysis, audit planning, procedures, and system processes
• Provide guidance and operational support to pharmacy audit operations teams, promoting best practices and leading project initiatives
• Analyze claims and audit data to support ongoing analytic efforts, identify trends, and recommend refinements
• Serve as subject matter expert for system enhancement initiatives and testing, representing the audit team in technology improvement discussions
• Execute and support audit-related initiatives while identifying business value opportunities

What We're Looking For

Required Qualifications:

• Bachelor's degree in Health Science or related field, or equivalent combination of education and experience (High School diploma or GED required at minimum)
• 5 years of experience in retail, long-term care, specialty, home infusion, or mail order pharmacy
• 3 years of work experience specifically in audit or quality assurance within a pharmacy setting
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• Must be eligible to work in the United States without need for visa sponsorship
• Proficiency in MS Word, Excel, and database software
• Demonstrated understanding of point-of-sale and online pharmacy claims processing environments
• Strong critical thinking, problem-solving, and decision-making abilities with capacity to assess risk and provide advice to partners
• Excellent communication skills with ability to distill complex concepts into clear messaging
• Ability to de-escalate potentially confrontational situations effectively

Preferred Qualifications:

• 5 years of previous audit experience
• Current registration with State Board of Pharmacy
• Previous pharmacy benefit management experience

How We Work With You

Candidates apply directly through Get A Job.ai. Our talent team will conduct an initial screening to understand your background and ensure alignment with the role requirements. We then submit qualified candidates to our client for consideration. Please do not attempt to contact the client directly, as all communication is managed through our recruiting process to ensure a professional and organized candidate experience.

Pay

Pay via Get A Job.ai will be discussed during the screening process based on your experience and qualifications. The position is remote within the United States.

Equal Employment Opportunity: Get A Job.ai is committed to fair and equitable recruiting practices. We work with clients who value diverse candidates and evaluate all qualified applicants without regard to race, color, religion, gender, national origin, disability, age, veteran status, or any other legally protected class.