Pharmacy Audit Representative

UnitedHealth Group - Irvine, CA3.6

Full-time
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Energize your career with one of Healthcare’s fastest growing companies.

You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our Service Centers, improve our Service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their Healthcare needs, and stay on track with their Health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation, and Performance.

Primary Responsibilities:
Positions in this function analyze and monitor claims against fraud, waste and abuse related to network pharmacies
Investigates, reviews and analyzes claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of fraudulent, erroneous, or abusive billing activity on Real Time Application System and various reports
Auditor will need to identify and documents fraudulent or erroneous activities determined as a result of their work. Auditors typically are licensed pharmacy technicians with in - depth knowledge of pharmacy operations

Required Qualifications:
High School Diploma / GED (or higher)
1+ years Pharmacy Technician experience in a retail pharmacy environment or some type of specialized pharmacy
Pharmacy Technician License that is current and valid in the state of California
Basic experience in Microsoft Word (creating / updating documents) and Microsoft Excel (creating / updating spreadsheets, pivot tables, and formulas)
Ability to work 8:00 am - 4:30 pm Monday through Friday as well as overtime as needed. Overtime could be before, after, or a different day than regularly scheduled shift

Preferred Qualifications:
National Pharmacy Technician Certification
Experience with Specialty Pharmacy
Experience with Medicare Part D and B
Pharmacy Benefit Management (PBM) knowledge / experience

Soft Skills:
Excellent written and verbal communication skills
Demonstrated ability to organize material from various, sometimes unrelated sources, analyze and draw logical conclusions
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.