Pharmacy Benefit Claims Auditor

This is an opportunity for a motivated individual who likes to work in a “can do” environment. Client commitments are the driving force of this company, which means that we’re looking for people who think through issues from a client’s point of view, who are willing to put in extra effort when needed, are sensitive to deadlines and committed to high-quality end product, and who take ownership of their work.

General Background

Fast growing medical claims auditing firm, located in downtown Pittsburgh, PA, that performs a comprehensive series of electronic audits and reviews designed to identify various claim payment error conditions for on-site analysis and validation. This is an opportunity for a very motivated individual who wants to grow in responsibility and who likes to work in a “can do” environment.

Overview of Work Parameters

The Pharmacy Benefit Claims Auditor position involves reviewing pharmacy benefit plans, working with an IT department to develop or amend programming logic to reflect different plan designs, reviewing computer printouts of erroneously paid claims, reviewing contract compliance provisions of pharmacy benefit management and pharmacy benefit plan limitations, selecting claims for on-site review at the claims administrator, participating in the on-site review of claims and developing and finalizing reports to reflect validated audit findings.

Minimum Requirements

1. Several years experience in the pharmacy benefit administration or pharmacy benefit claims processing industry.
2. Must be able to understand how specific pharmacy benefit plans are to be administered by reviewing the plan sponsor’s Summary Plan Descriptions and/or Benefit Booklets.
3. Good oral and written communication skills are required.
4. Computer skills such as knowledge of Excel, Word and Access is required.
5. Prior claims audit experience would be beneficial.
6. Knowledge and understanding of pharmacy benefit plans and/or knowledge of provider discount contracts and arrangements would also be beneficial.
7. The position may require the ability to travel several times per year, generally involving three to five days away from the company headquarters in Pittsburgh, PA.