Optum · 6 hours ago
Pharmacy Audit Analyst
Eden Prairie, MN
Full-time
Hybrid
Entry, Mid Level
$50K/yr - $89K/yr
2+ years expOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Pharmacy Audit Analyst role involves conducting pharmacy network audits, assessing compliance and documentation, and facilitating communication with pharmacy network providers while requiring significant travel across the U.S.
EducationHealth CareMedicalPharmaceutical
Responsibilities
This role requires nationwide travel by car, train and/or plane up to 75% of the year
Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectives
Perform onsite and desktop pharmacy network audits to identify potential discrepant pharmacy claims
Assess pharmacy site's physical premises, compliance with regulatory requirements, and completeness of records
Gather and review documentation up to but not including prescription hardcopies, signature logs, compounding records, and MARs
Facilitate answers to questions from pharmacy network providers on a rotational basis
Report findings to pharmacy network providers
Reviews and assesses quality and accuracy of audits conducted (QC)
Qualification
Required
Active and unrestricted Pharmacy Technician license in the state of residence
Active and unrestricted National Certification by the PTCB (Pharmacy Technician Certification Board)
2+ years of experience working in Pharmacy Audit, PBM, healthcare investigations or health insurance environment
2+ years of experience in a position processing pharmacy or medical claims
1+ years of experience leading in-person and virtual/desktop audits
Intermediate level of proficiency with pharmacy operations
Intermediate level of proficiency with Microsoft Office (Word - creating and editing documents, Excel - creating, filtering, and maintaining spreadsheets)
Intermediate level of proficiency in working independently and researching/conducting investigations
Currently located within 45 miles of International Airport
Ability to travel nationwide (car, train, plane) up to 75% of the year
Access to reliable transportation & valid US driver's license
Must be 18 years of age or older
Preferred
Certified Quality Auditor (CQA)
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)
Proficient in RxClaim or other pharmacy claims processing systems
Ability to solve problems including multiple priorities and research conflicting and/or inaccurate information
Must be self-motivated and can successfully investigate complex issue
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
Company data provided by crunchbase