Pharmacy Technician Claim Auditor – Evernorth

Location: Candidate must be located in one of the following areas: Pittsburg, PA; Philadelphia, PA; Cleveland, OH or Atlanta, GA.

The Pharmacy Auditor, Lead Analyst is responsible to identify pharmacy audit risks using analytical skills and audit tools and develop and execute audit plans and scope of procedures determined necessary to address those risks. The Staff Auditor will complete audits in order to correct risks identified and present findings to the Sr Audit Manager. The Staff Auditor may participate in third party audits and work collaboratively with cross functional partners to complete research needed and provide background knowledge needed to interpret audit scope. As a Staff Auditor, this position may act as a resource for less experienced team members and work on special projects as needed. The Auditor role will function as support of the Sr. Manager- Audit on some escalated issues and projects.

Essential Functions

• Perform efficient and effective audits to produce results consistent with departmental policies and critical corporate goals while meeting or exceeding personal production goals.
• Performance of audits includes obtaining, analyzing, and appraising evidentiary data on which to base an informed, objective assessment of the accuracy and legitimacy of claims audited.
• Utilizing personal knowledge of medications and available tools including the Enterprise Data Warehouse (EDW), Access, Excel, etc., identify pharmacies and claims representing audit risks and develop an audit plan, utilizing appropriate audit techniques, to efficiently and effectively address those risks.
• Develop and produce reports as required to meet needs of department management, Account Managers, pharmacies and chain audit contacts, clients and other stakeholders. Providing updates to management on current status of audits including any escalated issues.
• Prepare for and participate in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed audits, etc., for assigned clients.
• Perform special projects as assigned.
• Mentor less experienced team members to improve their understanding and skills by ensuring they are familiar with resource materials including manuals and systems.
• Responsible for the training of new associate auditors on departmental processes.
• Assist with post audit as required by management.

Qualifications

• 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 database and spreadsheet applications, ie: Microsoft Excel, Access, Word.
• Excellent organizational, interpersonal, and communication skills.
• Ability to work well with all levels of internal and external contacts.
• Ability to handle sensitive or confidential information is critical.
• Ability to work with minimum management oversight while performing audits.
• Ability to work a flexible schedule to accommodate project deadlines.
• Willingness to travel. Local travel for field audits within the metro area you live.
• Valid Driver's license required.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 68,700 - 114,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.