Pharmacy Technician, Claim Auditor

🔥 0 minutes ago

🏈 Ohio, Pennsylvania – Remote

🏈 Ohio – Remote 🔔 Pennsylvania – Remote

💵 $68.7k - $114.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Identify pharmacy audit risks using analytical skills and audit tools • Develop and execute audit plans and scopes of procedures • Complete audits to correct identified risks and present findings to the Senior Audit Manager • Participate in third-party audits • Collaborate with cross-functional partners to research and interpret audit scope • Act as a resource for less experienced team members and work on special projects • Support the Senior Manager–Audit on escalated issues and projects • Obtain, analyze, and appraise evidentiary data to assess the accuracy and legitimacy of audited claims • Use medication knowledge, the Enterprise Data Warehouse (EDW), Access, and Excel to identify pharmacies and claims representing audit risks • Develop reports for department management, Account Managers, pharmacies, chain audit contacts, clients, and other stakeholders • Provide management updates on audit status and escalated issues • Prepare for and participate in client communications, conference calls, and on-site meetings • Mentor less experienced team members • Train new associate auditors on departmental processes • Assist with post-audit activities

🎯 Requirements

• Bachelor's Degree preferred or equivalent work experience • 2+ years of pharmacy technician experience in a retail, long term care, specialty, mail order, or similar pharmacy setting, or equivalent education • Certified Pharmacy Technician (CPhT) preferred • Proficient in Microsoft Excel, Access, and Word • Excellent organizational, interpersonal, and communication skills • Ability to work with internal and external contacts at all levels • Ability to handle sensitive or confidential information • Ability to work with minimum management oversight while performing audits • Ability to work a flexible schedule to accommodate project deadlines • Willingness to travel locally for field audits within the metro area where located • Valid driver's license required • For home work, cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload

🏖️ Benefits

• Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Annual bonus plan eligibility • Remote/home work option with qualifying cable broadband or fiber optic internet connection