Job Summary
A health insurance company has a current position open for a Remote Pharmacy Audit Investigator.
Candidates will be responsible for the following:
- Analyzing and monitoring industry publications to be aware of fraud, waste, and abuse schemes
- Performing onsite and desktop investigative audits targeting potential Pharmacy FWA
- Adhering to all applicable requirements for case process and quality
Qualifications for this position include:
- Ability to travel up to 25% of the time
- High school diploma / GED or higher
- 2+ years working in pharmacy audit, PBM, healthcare investigations, or health insurance environment
- 1+ years pharmacy benefits management investigations experience
- 3+ years of experience in a position processing pharmacy claims and/or investigating fraud
- In – depth knowledge of pharmacy operations
