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Job Information

UnitedHealth Group Pharmacy Audit Analyst, Telecommute in NY or NJ or PA Travel up to 75% in New York, New York

Optum is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

This position requires travel (via car, plane, and train) within a specific demographic. Travel requirement can be up to 75% of the calendar year.

If you are located in New York, New Jersey, Pennsylvania, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectives

  • Perform onsite and desktop pharmacy network audits to identify potential discrepant pharmacy claims

  • Assess pharmacy site’s physical premises, compliance with regulatory requirements, and completeness of records

  • Gather and review documentation up to but not including prescription hardcopies, signature logs, compounding records, and MARs

  • Facilitate answers to questions from pharmacy network providers on a rotational basis

  • Report findings to pharmacy network providers

  • Reviews and assesses quality and accuracy of audits conducted (QC)

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High school diploma or GED

  • Current and unrestricted Pharmacy Technician License for the state of residence

  • Must be currently certified by the PTCB (Pharmacy Technician Certification Board)

  • 2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment

  • 2+ years of experience in a position processing pharmacy or medical claims

  • Experience with Microsoft Office (Word - creating and editing documents, Excel - creating, filtering, and maintaining spreadsheets)

  • Experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and have the ability to successfully investigate complex issues

  • Experience leading in person and virtual/desktop audits

  • In - depth knowledge of pharmacy operations

  • Ability to travel (car, train, plane) up to 75% of the year

  • Home Location within a commutable distance to an International Airport

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Bachelor’s Degree

  • Certified Quality Auditor (CQA)

  • Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial health insurance)

  • Proficient in RxClaim or other pharmacy claims processing systems

  • Ability to problem solve including multiple priorities and research conflicting and/or inaccurate information

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.