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.

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