Pharmacy Claims Auditor
Conduent
Conduent seeks a Pharmacy Claims Auditor to review and analyze pharmacy claims for accuracy, compliance, and contract adherence. In this role, you will audit high-volume transactional data, identify billing or coding discrepancies, validate pricing, and document findings in clear, data-driven reports. You will collaborate with internal teams and clients to resolve issues, recommend process improvements, and support regulatory and contractual requirements. Conduent’s performance-driven culture offers opportunities to grow through large-scale digital transformation and advanced analytics projects in healthcare and related sectors.
- Conduent seeks a Pharmacy Claims Auditor CPhT to review high-volume pharmacy claims for accuracy, compliance, and potential fraud, waste, or abuse. You will validate coding, pricing, eligibility, and formulary rules, investigate discrepancies, and document findings to support...Claims
- POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative...Claims
- ...Health is seeking a dedicated and detail-oriented Senior Integrity Auditor to join our Compliance team. This pivotal role is responsible... ...areas such as coding, billing, medical record documentation, claims, and clinical data. - Routinely review University Health’s revenue...Claims
$70k - $75k
...Best Workplaces in Financial Services & Insurance Attorney Auditor ** This is a fully remote position, and candidates residing... ...this or other roles. Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating...ClaimsLocal areaRemote workWork from homeFlexible hours- ...punctuality. The team is an extension of our customers' supply chain and pharmacy operations team. Compliance with our customers' requirements is... ...requirements to include inoculations and periodic testing. Auditors will work in warehouses, storerooms, clean rooms, and sterile...Suggested
- ...terminology and delineate when criteria are/are not met. Evaluates claims for conflict of interest and criteria appropriateness. Works... ...Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam...ClaimsExtra incomeFreelanceWork at officeRemote work
$100k
Join to apply for the Premium Field Auditor (Hybrid) role at Brown & Joseph AR Management | an ARMStrong IS Company 2 days ago Be among... ...LEADER-R&D - MANAGER-R&D - Quality Systems & Auditing Complex Claims Consultant - Architect & Engineer Liability GROUP LEADER-R&D -...ClaimsWeekly payFull timePart timeLocal areaImmediate startRemote workWork from homeHome office2 days per week3 days per week- ...Pharmacy Customer Associate I Location: This role will be based in TX-SAN ANTONIO, 4751 HAMILTON WOLF RD, STE 101. Schedule: This... ...party representatives, and other Blue Cross Plans) to provide claims, customer service, and/or membership support. Completes necessary...ClaimsTemporary workWork at officeLocal areaMonday to FridayShift workDay shift1 day per week
- ...Held Founded 1990 Employees 51-200 Specialties optimized access to supplemental networks claim cost repricer healthcare cost containment pharmacy cost containment pharmacy rebate optimization analytics and specialty pharmacy About the...Claims
- ...including a curated learning experience that will utilize your pharmacy knowledge and skills. Non-US Accredited Foreign Graduates are required... ...third party rejections and complete any manual claim formsPerform all prescription pick-up procedures, in adherence...ClaimsWork experience placementInternshipNight shift
$13 per hour
...healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery... ...in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform...ClaimsHourly payPrivate practice- ...Pharmacist provides comprehensive, patient-centered ambulatory clinical pharmacy services in collaboration with physicians and other members of... ..., prior authorization management, and analysis of pharmacy claims data to identify opportunities to improve clinical outcomes,...ClaimsFull timeMonday to Friday
- ...Pharmacy Technician – Prescription EntryThis position is primarily focused on prescription entry and pharmacy data entry activities. The... ...accuratelyManage financial transactions including insurance claims and copaymentsMaintain inventory on the pharmacy front end including...
- ...The main role of the pharmacy technician is processing prescriptions . The pharmacy technician will process and fill prescriptions and... ...Technicians include: Accepting Prescriptions Processing Insurance Claims Processing Prescriptions Other Pharmacy Technician Duties...
- ...Job Description Job Description **Certified Pharmacy Technicians Needed!** We are looking for a Pharmacy Care Coordinators to join... ...in a timely and detail-oriented manner. • Review prescription claim details and related documentation to support follow-up actions...ClaimsLong term contractWork at officeRotating shift
$19 per hour
...Reimbursement Specialist to join our healthcare team. The ideal candidate will be responsible for managing and processing medical claims, ensuring accurate reimbursement from insurance providers, and maintaining compliance with healthcare regulations. This role requires...ClaimsFull timeWork at office$19 - $22.5 per hour
...assists the pharmacist, under direct supervision, in the practice of pharmacy. Assists the pharmacist in the performance of other Pharmacy... ...those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and...ClaimsHourly payWork experience placementLocal areaImmediate startFlexible hoursAfternoon shift$16.5 - $25 per hour
...the best patient experience through assisting the pharmacist and pharmacy team members in accordance with state and federal regulations.... ...knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed),...ClaimsHourly payWork experience placementSummer internshipImmediate startFlexible hoursAfternoon shift$72.8k - $130k
...directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here... ...analytics2+ years of experience working with healthcare claims and reimbursement methodologies2 + years of experience - Advanced...ClaimsMinimum wageFull timeContract workWork experience placementWork at officeLocal areaRemote work$18 - $31 per hour
...the best patient experience through assisting the pharmacist and pharmacy team members in accordance with state and federal regulations.... ...knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed),...ClaimsHourly payInternshipImmediate startFlexible hoursAfternoon shift- ...adjusting experience is required for career-entry applicants. Are you interested in building a career as an Independent Insurance Claims Adjuster? With continued storm activity and catastrophic weather events across the country, experienced and properly trained adjusters...ClaimsFlexible hours
- ...Pharmacy Tech IIOur client, a Retail Pharmacy company, is looking for a Pharmacy Tech II for their San Antonio, TX location.Responsibilities... ...accurately manages financial transactions, including insurance claims and copayments.Manages inventory on the pharmacy front end,...Work experience placement
$248.5k - $373k
...directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here... ...expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the...ClaimsRemote jobMinimum wageFull timeWork experience placementLocal area- ...Job Description Job Description Certified Pharmacy Technician (CPhT) certification and 1+ years Pharmacy Technician experience required... ...& Documentation: Dispense medications, process insurance claims, maintain patient profiles, and file prescriptions efficiently....Permanent employmentContract workImmediate startShift work
- Independent Insurance Claims Adjuster (Licensed) Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity...Claims
- ...such as co-pays and deductibles, and generating reports for all of these activities. Duties may also require follow-ups on denied claims, daily insurance claims, and posting payments made by patients to their account. Responsibilities You will have to solve collection...Claims
- ...established and growing law firm is seeking a skilled and dedicated attorney with significant experience in first-party homeowner property claims to join its dynamic team. The ideal candidate will bring a strong background in representing policyholders in disputes with...ClaimsFull timeRelocation package
- ...Specialist to manage all aspects of medical AR collections for a physician medical group. This role will focus heavily on insurance claim denial follow-up, unpaid claims, payment recovery, billing issue resolution, and account management. Key Responsibilities Manage...Claims
- Kforce has a client in San Antonio, TX that is seeking an Auto Adjuster. Summary: Your work will focus on adjusting non-injury auto claims and you will work under supervision to investigate, evaluate, negotiate, and adjust low complexity auto insurance claims presented...ClaimsTemporary work
- ...established and growing law firm is seeking a skilled and dedicated attorney with significant experience in first-party homeowner property claims to join its dynamic team. The ideal candidate will bring a strong background in representing policyholders in disputes with...ClaimsFull timeRelocation package
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