This position will identify and investigate cases of suspected fraud and abuse for assigned clients and develop these cases in compliance with any applicable policies, procedures, or regulatory requirements. Analyze and evaluate potential fraud and abuse situations using corroboratory information obtained by correspondence with members, physicians, and pharmacies. Prepare formal and thorough written reports to expressing the findings of completed investigations. Manage the Fraud Tip Hotline by triaging calls, following up on allegations of suspected fraud and abuse, and referring them to the proper area for processing. Identify and perform special projects.
- BA/BS degree preferred or equivalent work experience,
- Requires 1-3 years of relevant experience as a pharmacy technician, health care professional, or data analyst
- Certified Fraud Examiner, Certified Pharmacy Technician, or similar certification strongly desired
- Highly proficient in Microsoft Access & Excel, and data warehousing applications
- Excellent communication (oral and written) organizational and interpersonal skills, critical thinking and planning skills, and written communication skills
- Ability to handle sensitive or confidential information is critical
- Ability to work with minimum management oversight on multiple projects with competing priorities
- Ability to work a flexible schedule to accommodate project deadlines
- Ability to travel an average of 25%
Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class.
None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.
Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.
- 2 years ago - save job
Express Scripts is a Fortune 25 company and is the largest pharmacy benefit manager in the U.S.