Job details
Job type full-time number of hires for this role 1
Full job description
Company overview
Caribou systems is a premier consulting firm that specializes in providing comprehensive business and technical systems expertise to the healthcare industryFounded in 1994, csi has two well-established business practices, pharmacy claims management and it consulting services for healthcare claims and related systemsCsi has chosen to focus our pharmacy practice strictly on pharmacy claims auditing and data analysis because our goal is to provide the best-in-class services in this specific areaThis focus allows us to maintain our level of expertise in an ever-evolving marketplace while avoiding conflicts of interest across service offerings.
Position description
Caribou systems is looking for a highly motivated individual to join our pharmacy audit practice as manager of pharmacy claim auditsThis individual must possess the following qualities:
Highly knowledgeable in pbm audits
Expert understanding of pbm claims data, contracts, and benefit plan design documents
Ability to provide oversight of the audit process and interpret audit results
Strong analytical background with demonstrated critical thinking and problem-solving experience
Ability to develop and perform custom audit analytics
Ability to communicate effectively and professionally with internal and external stakeholders
Self-confident individual with excellent leadership and interpersonal skills
Must have outstanding time management and organizational skills with high attention to detail
Articulate with excellent written and verbal communication skills
Self-motivated, with 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 work efficiently in a remote team environment, with other auditors and programmers
Ability to handle sensitive or confidential information is critical
Responsibilities
Peer review audits to ensure compliance with established audit process and engagement contracts
Provide guidance, expertise, and problem-solving support to the audit team in review of claims data, pbm contracts, and benefit plan design documents to determine appropriate next steps in the audit process
Prepare audit reports to document final audit results
Recommend process improvements to support an efficient and thorough audit process
Communicate effectively with vendors, clients, and consultants to resolve issues
Qualifications
Minimum 5 years work experience in pbm auditing in a capacity that involves leading team members to perform claim analysis
Expert knowledge of pharmacy claims processing
Other skills
Highly proficient in excel
Proficient in word, powerpoint, and outlook
Job type: full-time
Benefits:
401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance
Schedule:
Monday to friday
Work location:
Fully remote
Work location: remote
