POSITION DESCRIPTION Energize your career with one of Healthcare's fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UNITEDHEALTH GROUP is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: OPTUM - a growing part of our family of companies that make UNITEDHEALTH GROUP a Fortune 6 leader. OPTUM helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance. 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. 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. 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
• Adheres 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
• Works on special projects as assigned
• Supports the training and development of Sr. Auditors
• Provides ideas and recommendations on process improvements

Local Telecommute locations include: New York, New Jersey, Dallas, TX OR Detroit, MI OR Miami, FL OR Tampa, FL 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 experience with pharmacy benefits management pharmacy audit experience and/or healthcare investigations
• 3+ years of experience in retail pharmacy and/or a position processing pharmacy claims
• In-depth knowledge of pharmacy operations
• Current and unrestricted Pharmacy Technician License or Registration for the state of residence (if required by state)
• Must be currently certified by the PTCB (Pharmacy Technician Certification Board)
• Proficient in Microsoft Office Tools with the ability to learn new applications including Microsoft Word (creating, saving, and formatting documents), Microsoft Excel (creating, saving, and using formulas) and Microsoft PowerPoint (create and edit slides)
• Ability to travel up to 25% of the time

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)

SOFT SKILLS:

• Excellent communication skills, written and verbal
• Strong organizational skills; must be detail-oriented

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. 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 healthcare 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. Join us and start doing YOUR LIFE'S BEST WORK.SM 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 Keywords: Investigator, Pharmacy Tech, Pharmacy Technician, PTCB, PBM, fraud, investigations, Irvine, CA, California Job Details

• CONTEST NUMBER 844703
• JOB TITLE Pharmacy Audit Investigator - Irvine, CA or Local Telecommute in Multiple Locations
• JOB FAMILY Regulatory and Compliance
• BUSINESS SEGMENT OptumRx

Job Location Information

• Irvine, CA United States North America
• OTHER LOCATIONS New York, NY New Jersey, NJ Dallas, TX Detroit, MI Miami, FL

Additional Job Detail Information

• EMPLOYEE STATUS Regular
• SCHEDULE Full-time
• JOB LEVEL Individual Contributor
• SHIFT Day Job
• TRAVEL Yes, 25 % of the Time
• TELECOMMUTER POSITION Yes
• OVERTIME STATUS Exempt

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.