Pharmacy Claims Audit Supervisor

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Lead and nurture a team tasked with drug claims auditing and adjudication functions.

• Supervise claim audit processes to ensure accuracy, promptness, and adherence to PBM and Medicaid regulations.

• Track productivity, quality, and turnaround-time performance indicators.

• Introduce process enhancements to uncover discrepancies.

• Manage escalations and resolve intricate claims challenges involving members, providers, and pharmacies.

• Collaborate with internal teams regarding system updates, audits, and the continuous management of claims operations.

• Engage with state representatives to present audit findings, create new capabilities, and oversee appeal processes.

• Provide leadership in a high-volume audit processing setting.

• Work in partnership with pharmacy, clinical, client, and IT teams.

⛳️ Requirements

• Must possess a valid Pharmacy Technician certification (CPhT), such as from PTCB.

• Over 5 years of experience in PBM, pharmacy operations, drug claims processing, and audit functions.

• At least 2 years of leadership or supervisory experience.

• Strong expertise in identifying drug claim discrepancies and pharmacy audit procedures.

• In-depth knowledge of pharmacy claims adjudication and Medicaid programs.

• Proven experience in client communications and leading discussions with clients.

• Familiarity with operational reporting, KPIs, and process enhancement initiatives.

🏝️ Benefits

• Flexible working hours and options for remote work.

• Emphasis on work-life balance.

• Comprehensive medical, dental, and vision coverage.

• 401(k) savings plan options.

• Employer matching for 401(k) contributions.

• Flexible vacation policy.

• Educational support and assistance.

• Access to leadership and technical development academies.

• Opportunities for career growth and ongoing learning.