Missouri Licensed Pharmacy Audit Supervisor

Job Summary

Supervising pharmacy claims audit operations remotely, the full-time Missouri Licensed Pharmacy Audit Supervisor will lead a team focused on ensuring accurate adjudication of pharmacy claims while maintaining compliance with Medicaid requirements and operational performance standards.

Key responsibilities

• Lead and develop a team responsible for drug claims auditing and adjudication activities
• Oversee claim audit workflows to ensure accuracy, timeliness, and compliance with PBM and Medicaid guidelines
• Monitor performance metrics and implement process improvements to identify discrepancies

Required qualifications

• Active Pharmacy Technician certification (CPhT), such as PTCB
• 5+ years of experience in PBM, pharmacy operations, drug claims processing, and audit operations
• 2+ years of leadership or supervisory experience
• Strong knowledge of pharmacy claims adjudication and Medicaid programs
• Experience with operational reporting, KPIs, and process improvement