Pharmacy Claims Audit Supervisor

Job Summary

Supervising claims audit operations remotely, the full-time Pharmacy Claims Audit Supervisor will lead a team in 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

• 5+ years of experience in pharmacy operations, drug claims processing, audit, or related healthcare environments
• 2+ years of leadership experience managing teams and driving performance
• Strong expertise in pharmacy claims adjudication, Medicaid programs, and audit processes
• Nationally Certified Pharmacy Technician (CPhT) required; CFE or AHFI certification preferred
• Experience with client communications and driving operational improvements