Integrity Auditor (Pharmacy Call Center)

Pharmacy Integrity Auditor

Job Description Summary

Role Responsibilities

This individual will report to the program integrity Associate Manager and act as a shared resource in collaboration with various program teams to review both chain and independent pharmacy audit requests.

Principal Accountabilities:

• Responsible for conducting pharmacy claims audits at the request of operations and management teams. May leverage health care providers, medical facilities, various billing portals, and contracting teams, as necessary.

• Responsible for collaboration with pharmacy facilities to acquire and review documentation necessary for assessing and validating compliance of claims against program business rules.

• Exercise independent judgment to determine appropriate corrective action of noncompliant claims, notify pharmacies of findings, and provide instructions on the appropriate corrective action. This can include potential reversal, refund, or reprocessing of claims.

• Document all details pertaining to claims audits and provide a summary to appropriate management team members.

• Provide interpretation and consultation to project teams on project specific guidelines/instructions and policies and procedures.

• Evaluate applicable regulations/guidelines, customer requirements, Standard Operating Procedures (SOPs) and project specific guidelines/instructions to assist with planning, scheduling, conducting, reporting and closing internal audit activities, as time permits.

• Self-starter able to carry out job responsibilities with minimal supervision.

• Possess exceptional organizational skills.

• Capable of recognizing operational challenges and collaborating with team to design solutions.

• Requires the ability to handle multiple simultaneous tasks with various deadlines while prioritizing urgent requests.

Required Skills

• High School diploma or equivalent

• Previous auditing experience working in a customer care environment of at least 2 years

• Excellent problem solving, telephone and communication skills

• Good customer relationship skills

• Ability to exercise independent judgment, appropriate discretion, and escalate to management as appropriate.

• Ability to rapidly adapt to new technologies and assess their potential impact and usefulness in diverse areas within the company

• Ability to work flexibly with the team to ensure timely delivery of service

• Ability to produce high quality work under pressure and within tight timescales

• An ability to work within tight deadlines and manage time effectively.

• Strong team player with flexible attitude to work priorities.

• Excellent computer skills (MS Office applications)

• Amenable to reporting in flexible, shifting schedules and onsite in Taguig

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.