On Site Pharmacy Auditor - Remote

Job TitleOptum 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.This position requires travel (via car, plane, and train) within a specific demographic. Travel requirement can be up to 75% of the calendar year.If you are located in Washington, Oregon, or California, you will have the flexibility to work remotely* as you take on some tough challenges. Will be onsite - traveling up to 75% of the time.Primary Responsibilities:Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectivesPerform onsite and desktop pharmacy network audits to identify potential discrepant pharmacy claimsAssess pharmacy site's physical premises, compliance with regulatory requirements, and completeness of recordsGather and review documentation up to but not including prescription hardcopies, signature logs, compounding records, and MARsFacilitate answers to questions from pharmacy network providers on a rotational basisReport findings to pharmacy network providersReviews 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 or GEDCurrent and unrestricted Pharmacy Technician License for the state of residenceCurrently certified by the PTCB (Pharmacy Technician Certification Board)2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment2+ years of experience in a position processing pharmacy or medical claimsExperience leading in person and virtual/desktop auditsExperience with Microsoft Office (Word - creating and editing documents, Excel - creating, filtering, and maintaining spreadsheets)Experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and have the ability to successfully investigate complex issuesIn - depth knowledge of pharmacy operationsAbility to travel (car, train, plane) up to 75% of the yearHome Location within a commutable distance to an International AirportFull COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodationPreferred Qualifications:Bachelor's DegreeCertified Quality Auditor (CQA)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 systemsAbility to problem solve including multiple priorities and research conflicting and/or inaccurate informationCareers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.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.