Pharmacy Fraud Senior Analyst-Evernorth-Remote

The job profile for this position is Fraud Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.

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Job Description:

The Investigator role is responsible for the development, investigation, and presentation of complex fraud and/or abuse cases.  Using analytical skills, in-depth drug and medical expertise, and audit tools, independently develop and execute investigation plans including the scope of procedures necessary to address risks in order to formalize sound recommendations for the investigation.  A substantiated case, subject to certain criteria, will result in an in-depth referral to commercial and government clients.

Key Responsibilities:

• Analyze information gathered by investigation and report findings and prepare written summary/recommendations

• Lead virtual interviews of member/providers and pharmacies as necessary to obtain necessary information regarding the investigation

• Prepare reports to expedite tracking and reporting of investigations

• Prepare evidence package referrals to internal and external parties including; contract holders, law enforcement agencies/medical boards

Minimum Requirements:

• Clear and concise verbal and written communication skills

• Strong computer skills are required – Excel, Access and Word

• 2 years Fraud Investigative or Pharmacy experience

• Bachelor’s Degree and/or pharmacy benefit management experience in lieu of degree

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

Please note that you must meet our posting guidelines to be eligible for consideration.  Policy can be reviewed at this link.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.