Remote Senior Pharmacy Claims Audit Leader
Prime Therapeutics
- Remote job
Prime Therapeutics is seeking a Senior Pharmacy Claims Auditor to remotely lead audit initiatives and develop tools, analytics, and training to identify waste and ensure compliance in pharmacy reimbursements. The role requires a Bachelor’s in Health Science or related field, 5 years in pharmacy with audit/QA, and a PTCB/ExCPT certification. Strong data analysis, cross-functional collaboration, and SME capability are essential. #J-18808-Ljbffr Prime Therapeutics
- ...Pharmacy Technician Senior - Inpatient The Senior Pharmacy Technician supports various aspects of pharmacy... ..., including prescription order entry, claim adjudication, medication preparation... ...Circle Tampa 33601 Eligible for Remote Work: On Site Job Pharmacy Organization...Remote workSeniorClaimsShift work
- ...Pharmacy Technician Senior - Outpatient RetailThe Senior Pharmacy Technician supports various aspects... ..., including prescription order entry, claim adjudication, medication preparation and... ...General Circle Tampa 33601 Eligible for Remote Work: On...Remote workSeniorClaimsShift work
- ...Hutchinson Cancer Center in Seattle is seeking a Pharmacy Billing Technician to interpret and process billing data, evaluate claims, and communicate with care teams and vendors.... ...Office skills. This role may be hybrid or remote based on business needs. #J-18808-Ljbffr...Remote jobSeniorClaimsWork at office
$81k - $138k
...purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Senior Underwriter - Remote Job Description The Senior Underwriter is... ..., many of which are very complex Performs claims re-pricing analyses for the most complex external...Remote workSeniorClaimsWork experience placementLocal areaVisa sponsorshipWork visa- Job title - Senior Pharmacy Operations Analyst - Medicare Job location type - Remote Job type - 12 months contract with possible extension... .... Support Medicare pharmacy claims processes and reporting... ...CMS submission processes and audit readiness standards. #J-18808...Remote workSeniorClaimsContract work
$24 - $43 per hour
...Senior Medical Coder Optum is a global organization... ...people with the care, pharmacy benefits, data and resources... ...within charge review, claim edits, and denials and... ...8am - 5pm Location: Remote Nationwide You will... ...medical coding quality audits Educate and mentor...Remote workSeniorClaimsHourly payMinimum wageFull timeWork experience placementLocal areaMonday to Friday$91.7k - $163.7k
...outcomes by connecting people with the care, pharmacy benefits, data and resources they need to... ...with clients, business partners, or senior stakeholders in a client-service, account... ...of pharmacy benefit operations, including claims, prior authorization, eligibility, benefit...Remote workSeniorClaimsMinimum wageFull timeWork experience placementWork at officeLocal area$69.4k - $99.2k
...in days) to receive an alert: Senior Business Analyst Date: Aug 27... ...Post payments to medical and pharmacy claims from paper and electronic... ...should expect in this role Fully remote opportunity from most US... ...Gainwell Company , an industry leader. You'll be joining a company...Remote workSeniorClaimsFull timeFlexible hours- ...Senior Medical Analyst - Skipta Company: Norstella Location: Remote, United States Date Posted: Aug 25, 2026 Employment Type: Full... ...data (RWD) sources, including claims, laboratory results, billing codes... ..., Epidemiology, Public Health, Pharmacy (PharmD), Medicine (MD/DO), or...Remote workSeniorClaimsFull timeTemporary workLocal areaFlexible hours
$140k - $160k
...executive-level leadership for Pharmacy Benefit Management (PBM)... ...reliable pharmacy solutions. This leader partners closely with business... ...and PBM platforms, including claims adjudication (NCPDP D.0/F6), formularies... ...expect in this role Remote opportunity to work anywhere...Remote workSeniorClaimsFull timeFlexible hours$44.9k - $64.1k
...steps. Our partner is looking for a Certified Senior Pharmacy Technician based in United States. This fully remote role supports pharmacy benefit operations while... ...with pharmacy prior authorizations, prescription claims, medication terminology, and member, provider,...Remote workSeniorClaimsFull timeWork from homeMonday to FridayFlexible hours$72.8k - $130k
...Network Management REMOTE IN WICHITA, KS Optum... ...people with the care, pharmacy benefits, data and resources... ...together. The Senior Account Manager has geographic... ...alongside operational leaders, to monitor utilization... ...problems, to include claims and member support...Remote workSeniorClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to Friday$91.7k - $163.7k
...outcomes by connecting people with the care, pharmacy benefits, data and resources they need to... ...will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges... ...of Facets Trizetto, with a focus on claims and provider setup CPC or other coding certification...Remote workSeniorClaimsMinimum wageFull timeWork experience placementLocal area$130k - $150k
...Position Overview The Senior Data Analyst will be a key member... ...patient picks it up at the pharmacy, we can uniquely identify and... ...in the US. #LI-GF1 #LI-Remote Benefits ~ Competitive... ...encounter any communications claiming to be from DrFirst that seem...Remote workSeniorClaimsTemporary workFlexible hours$44.9k - $64.1k
...Join Gainwell as a Certified Senior Pharmacy Technician and play an... ...and pharmacies. In this fully remote role, you will serve as a pharmacy... ...authorizations, prescription claims, medication terminology, and... ...career with Gainwell, an industry leader. You’ll be joining a company...Remote workSeniorClaimsFull timeWork from homeMonday to FridayFlexible hours$112.7k - $193.2k
...connecting people with the care, pharmacy benefits, data and resources... ...authorization workflows.This Senior Product Manager owns product... ...the flexibility to work remotely * from anywhere within the U.... ...management, prior authorization, or claims systems, including clinical...Remote workSeniorClaimsMinimum wageFull timeWork experience placementWork at officeLocal area- ...today and prepare leaders for the future. We... ...Description Senior Director, Financial... ...of EHP's medical, pharmacy, and administrative... ...internal and external audit processes,... ...reserve management, claims lag analysis, and... ...the right to change remote work status with notice...Remote workSeniorClaimsContract workWork from homeFlexible hours
- ...team is a recognized leader in health care and... ..., providers, pharmacies, and law firms.Role... ...compliance, legal, audit, operations, nursing... ...; Federal False Claims Act and Anti-Kickback... ...Partner/Director/Senior Management level -... ...future.#LI-NT1#LI-Remote*Ankura is an...Remote workSeniorClaimsFull time
$134.6k - $230.8k
...connecting people with the care, pharmacy benefits, data and resources... .... Growing together.The Senior Director, Medical Contracting... ...enjoy the flexibility to work remotely * from anywhere within the U.... ...agreementsExperience leveraging claims analytics, market...Remote workSeniorClaimsMinimum wageFull timeContract workWork experience placementLocal area$180.4k - $225.5k
Senior Machine Learning Engineer II Charlotte, North Carolina, United... ...with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit... ...that enable collaboration in a remote environment. This position description...Remote workSeniorClaimsLocal areaFlexible hours$20 - $36 per hour
...Senior Enrollment Representative Optum is a global... ...people with the care, pharmacy benefits, data and resources... ...The position conducts audits, identifying process... ...time zone Location: Remote - Nationwide You will... ...and resolve claim denials, reimbursement...Remote workSeniorClaimsHourly payMinimum wageFull timeWork experience placementLocal areaMonday to FridayFlexible hours$122.2k - $174.6k
.... Summary The Senior Manager, Interfaces & Integration... ...-scale Medicaid, MMIS, Pharmacy Benefit Management, or... ...member, provider, claims, formulary, clinical,... ...in this role Fully Remote Opportunity – Work from... ...Gainwell, an industry leader. You’ll be joining a company...Remote workSeniorClaimsFull timeFlexible hours$112.7k - $193.2k
...connecting people with the care, pharmacy benefits, data and... .... Growing together.The Senior Product Manager is a strategic product leader responsible for defining... ...'s Professional Claim Review products. These are... ...the flexibility to work remotely * from anywhere within the...Remote workSeniorClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaShift work$243.8k - $304.8k
Senior Director, Clinical and Translational Research Remote, USA Omada Health is on a mission to inspire and engage people... ...studies, economic models, healthcare claims analyses, and real‑world... ...customers include health plans, pharmacy benefit managers, health systems...Remote jobSeniorClaimsLocal areaWork from homeFlexible hours$203.2k - $348.4k
...people with the care, pharmacy benefits, data and resources... ...Growing together. The Senior Director, Data & AI... ...a strategic technology leader responsible for defining... ...the flexibility to work remotely * from anywhere within... ...data domains including claims, formulary, clinical, rebate...Remote workSeniorClaimsMinimum wageFull timeWork experience placementWork at officeLocal area$70k - $75k
...Senior Medical Economics Analyst Job No: 54301... ...environments, including remote work opportunities. With... ...leadership, program leaders, and healthcare stakeholders... ...You will analyze claims, encounters, membership... ...Medicaid claims, encounters, pharmacy, utilization,...Remote workSeniorClaimsFull timePart timeInternshipWork at officeFlexible hours- ...development. Summary As a Senior Certified Pharmacy Technician in Gainwell’s... ..., including pharmacy claims, claim rejections,... ...this role This is a 100% remote position requiring a reliable... ...with Gainwell, an industry leader. You’ll be joining a company...Remote workSeniorClaimsFull timeFlexible hoursShift workNight shiftAfternoon shift
$120.1k - $214.5k
...connecting people with the care, pharmacy benefits, data and resources... .... Growing together. Senior AI/ML Engineer - Optum Health... ...on high‑impact areas such as Claims Processing Automation, Eligibility... ...Responsible AI governance and auditability standards. Partner closely...Remote jobSeniorClaimsMinimum wageFull timeWork experience placementLocal area$93.2k - $147k
...delivering full‑service pharmacy benefit management (PBM... ...which consolidates all claim administration‑related... ...Pharmacy Value Programs Senior Project Manager will... ...compliance through structured audits and documentation. The... ...location of the job. Remote, US Salary Range: $93,2...Remote workSeniorClaimsWork at officeLocal areaFlexible hours- ...is one of the nation’s leading pharmacy care management companies that... ...50 states. Job Details The Senior Data Engineer maintains complex... ...Assist in troubleshooting pharmacy claim related issues , reports and... ...adjusted as needed. This is a remote position. AnewHealth offers a...Remote workSeniorClaimsFull timeTemporary workLocal areaFlexible hours
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