Pharmacy Audit Representative - Irvine, CA

Position Description: We're changing the way health care works for the better. That means consulting with our members, partnering with our physicians, and delivering drugs in the most efficient and effective way. Join us and start doing your life's best work. Positions in this function analyze and monitor claims against fraud, waste and abuse related to retail pharmacy and long-term care networks. 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. May conduct on-site audits at pharmacies, physician offices and long-term care facilities. Site audits include assessment of physical premises, compliance with regulatory requirements, and completeness of provider/clinical records and itemized bills. Identifies and documents fraudulent or erroneous activities determined as a result of an audit. Prepares audit reports and determines overpayments. Formal documentation may be prepared for chief compliance officer and company attorneys. Notifies and works with government enforcement agencies as appropriate. Auditors typically are licensed pharmacy technicians with in-depth knowledge of pharmacy operations. Nationally certified technicians and technicians with investigative experience are preferred.Primary Responsibilities: Moderate work experience within own function.Some work is completed without established procedures.Basic tasks are completed without review by others.Supervision/guidance is required for higher level tasks.

Required Qualifications:High School or GEDPharmacy Tech License required for the State of California2+ years of experience as a Pharmacy TechnicianAbility to create, edit save, and file documents in Microsoft Word and Excel.Preferred Qualifications:National Certification as Pharmacy Technician5+ years of experience as a Pharmacy Technician working in retail Pharmacy, Long Term Care or Specialty Pharmacy2+ years experience processing drug claims in Medicare Part D and BPharmacy Benefit Management (PBM) knowledge/experienceSoft Skills:Demonstrated ability to organize material from various, sometimes unrelated sources, analyze, and draw logical conclusions.Excellent written and verbal communication skills to be used to communicate professionally with Customers, and colleagues.OptumRx is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. 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 health care 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. 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. In the largest and most personal sense, your impact can be greater than even you thought at OptumRx.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.