An employer is looking for a highly skilled claims / pharmacy audit rep to join one of our largest national healthcare clients for a contract-to-hire opportunity. In this role you will review utilization management documents, which are drug product clinical criteria to approve a pharmacy claim, and are being digitized from a PDF document via an automated robot job. In this role you will audit of the digitized results of the robot copying function compared to the original UM text and documents. In this role you will work with 5 additional contractors to ensure the digitized documents match the original word files. You will complete around 10 audits an hour to complete the 29,000 in their audit queue.
Responsibilities:
- Compare the original drug approval criteria document to the translated, digitized format that was auto-copied via the robot IT tool. ~29,000 criteria documents in all to review.
- Make edits/updates to those documents are errors are found.
- Ensure that defined milestones, target completion dates and quality levels are achieved.
- May leverage automated document comparison techniques/tools to compare such documents.
-1-3 years of prior authorization and/or utilization management and /or criteria entry experience.
-1-3 years of PBM experience / knowledge
-1-3 years of web tool and excel experience
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.