Pharmacy Claims Auditor – Remote

About the role

The Pharmacy Claims Auditor works remotely to identify waste and ensure compliance within Prime Therapeutics' pharmacy network. You will analyze large claim datasets, educate pharmacies on best practices, and support audit‑related projects that drive value for Prime and its clients.

Key responsibilities

• Conduct in‑depth analysis of large datasets to detect high‑risk pharmacy claims and billing irregularities.
• Select audit samples strategically, prioritizing claims based on risk indicators and compliance concerns.
• Evaluate claims and supporting documentation against contractual terms, provider policies, and state/federal regulations.
• Educate network pharmacies on documentation standards and compliance best practices.
• Support audit‑related projects, identify audit trends, and recommend business‑value opportunities.
• Perform other duties as assigned.

Required profile

• Bachelor’s degree in Health Science or related field, or equivalent experience.
• Minimum 2 years experience in retail, long‑term care, specialty, home infusion, or mail‑order pharmacy, or combined pharmacy and PBM experience.
• At least 1 year in an operations, audit, or quality‑assurance environment.
• National Pharmacy Technician Certification (PTCB, ExCPT).
• Eligibility to work in the United States without visa sponsorship.

Required skills

• Proficiency in Microsoft Word.

What we offer

• Purpose‑driven career in a leading pharmacy benefit manager.
• Remote work flexibility.
• Opportunities for professional growth and impact on healthcare outcomes.