Vacancy expired!
Here's a statistic that will stop you cold: Our country spends nearly $3 trillion on health care annually. With that kind of money at play, you can be sure some individuals will figure out a way to get a piece of it illegally. Now, that doesn't even take into account the millions of lives that are held in the balance as well. This is fraud on a scale you couldn't begin to imagine. As a Pharmacy Audit Investigator, you will play a part in putting a stop to it. It's critical work that that you will want to be a part of. Apply today.The challenge for you will be the high volume of cases on your plate at one time. You will be part of a team responsible for triaging, investigating and resolving instances of healthcare fraud and / or abusive conduct.You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:Analyzes and monitors industry publications to be aware of fraud, waste, and abuse (FWA) schemes (PLATO, CMS / MEDIC, OIG, Google Alerts, etc.) impacting pharmacy business
Perform onsite and desktop investigative audits targeting potential Pharmacy FWA
Adhere to all applicable requirements for case process and quality
Prepares reports and presentations based on case results
Conducts onsite audits at pharmacies to assess physical premises, compliance with regulatory requirements, and completeness of records
Collaborates with Manager, Sr. Investigator, and Sr. Auditors to support overall FWA prevention and detection efforts and ensure case quality
Work on special projects as assigned
Support the training and development of Sr. Auditors
Provides ideas and recommendations on process improvements
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 / GED or higher
2+ years of experience 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
Current and unrestricted Pharmacy Technician License for the state of residence
Must be currently certified by the PTCB (Pharmacy Technician Certification Board)
Microsoft Office (Word - creating and editing documents, Excel - creating and maintain spreadsheets)
Ability to travel up to 25% of the time
Monday through Friday 6am to 3pm, 7am to 4pm or 8am to 5pm PST
If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas, In addition, employees must comply with any state and local masking orders.
Preferred Qualifications:Bachelor's degree or higher
Proficient in RxClaim and Online Reporting
An 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)
Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI)
UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.Some of the steps we’ve taken to ensure employee well-being include:Transitioned our new hire training classes to be conducted virtually
Launched our ProtectWell app and UnitedCARES program to help ease the burden and stress for our UnitedHealth Group team members and their immediate family affected by COVID-19
Daily updates from our CEO Dave Wichmann to support and inspire team members during this challenging time
Onsite social distancing and increased sanitization measures for employees who have been welcomed back to our offices
Fully cover the COVID-19 healthcare costs for our employees
Employees who self-identify as high risk or who live with someone who is high risk have been asked to remain working from home
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter PolicyYou can learn more about all we are doing to fight COVID-19 and support impacted communities at: click here at https://www.unitedhealthgroup.com/newsroom/addressing-covid.html .What we do defines who we are. Take a deeper look at how we're providing support during this global health crisis and search for a way you can get involved. View our COVID-19 Resources Page: click here at https://info.uhg.com/ .Colorado Residents Only: The hourly range for Colorado residents is $43,200 to $76,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, in addition to your salary, UnitedHealth Group offers the following benefits for this position, subject to applicable eligibility requirements: health, dental and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term and long-term disability insurance; business travel accident insurance; employee assistance program; paid time off; and employee-paid critical illness and accident insurance.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 employmentKeywords: Investigator, Pharmacy Tech, Pharmacy Technician, PTCB, PBM, fraud, investigations, Irvine, CA, California, Telecommute, remote, work from home, work at home, WFH, WAH, hiring immediately
