Claims Audit Specialist
Job Summary
Contributing to the integrity of pharmacy benefit management, the full-time Claims Audit Specialist will conduct audits of pharmacy insurance claims, ensuring compliance with client-specific benefits and resolving discrepancies in a remote work environment.
Key responsibilities
- Conduct routine audits of pharmacy claims to ensure accuracy and compliance with client contracts
- Research and analyze discrepancies, documenting findings and initiating corrective actions
- Prepare regular audit reports summarizing findings and resolution statuses
Required qualifications
- High school diploma or equivalent GED
- Eligibility to work in the United States without the need for work visa or residency sponsorship
- Ability to interpret complex pharmacy plan benefits and apply payment determinations
- Understanding of contracts and insurance principles related to claims adjudication
- Experience with data validation and claims audit processes
Complete Job Description
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