Apply for the Pharmacy FWA Investigator role at Centene Corporation . You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Position Purpose Investigates allegations pertaining to Pharmacy Fraud, Waste and Abuse (FWA) and develops strategies to effectively research specific FWA schemes. Recommends effective remedial actions for a pharmacy (e.g., pharmacy network termination; corrective action plans) when a credible allegation of fraud exists. Proactively analyzes pharmacy claims and other available data sources to identify FWA schemes. Responsibilities Investigate allegations pertaining to Pharmacy Fraud, Waste and Abuse and develop strategies to effectively research specific FWA schemes. Prepare and submit evidentiary documents and cases for presentation to the Pharmacy Network Review Committee (PNRC). Accurately document investigations and aggregate data for internal reporting of outcomes and recoveries. Prepare cases for referral to appropriate parties as determined by the evidence and regulatory requirements. Proactively analyze pharmacy claims and other available sources of data to identify FWA schemes and aberrant activity to generate pharmacy leads. Recommend effective remedial actions of a pharmacy (e.g., pharmacy network termination; corrective action plans) when a credible allegation of fraud exists. Perform other duties as assigned. Comply with all policies and standards. Additional Job Specific Details And Skills Pharmacy Technician or Pharmacy Coordinator experience. Proficiency with Excel and databases. Analytical skills – data analysis, claims analysis and reports with large volumes of claims. Thrives on data analysis and frequent change in direction. Experience utilizing strategies to improve processes. Exceptional critical thinking skills. Strong decision making and problem‑solving skills. Good organization and time‑management skills. FWA or audit experience, highly preferred. Experience in Retail Pharmacy, highly preferred. Working Shift 8 am – 5 pm or 8:30 am – 5 pm Monday–Friday (Eastern/EST). Education & Experience An associate’s degree in a related field or equivalent combination of experience. Pharmacy Technician or Pharmacy Coordinator (i.e., hospital and/or retail environments or related experience with a Health Plan or Pharmacy Benefit Manager) required. Previous experience with government programs such as Medicare and Medicaid. Preferred – 2+ years of experience in claims auditing and/or pharmacy investigations. License / Certification Preferred – Certified Pharmacy Technician (CPhT). Preferred – Accredited Health Care Fraud Investigator (AHFI – NHCAA). Compensation & Benefits Pay range: $22.79 – $38.84 per hour. Centene offers a comprehensive benefits package, including health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and a flexible approach to work with remote, hybrid, field or office schedules. Pay will be adjusted based on individual skills, experience, education, and other job‑related factors permitted by law. EEO & Equal Opportunity Statement Centene is an equal‑opportunity employer committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act. Get notified about new Investigator jobs in Greater Enid Area . #J-18808-Ljbffr Centene Corporation
...Job Summary $18/hour. Part-Time. Must be based in Prospect Heights, IL area. The Transport Specialist is responsible for delivering... ...and clients. Essential Duties and Responsibilities Drive a delivery van to deliver product orders to clients. Follow...
...produce compelling content across digital and traditional marketing channels. The ideal candidate has a strong grasp of brand voice, writes with clarity and persuasion, and collaborates cross-functionally to support marketing and sales initiatives. This role helps drive...
...and ensuring safety compliance. Ideal candidates will have EPA certifications and a valid driver's license. Competitive hourly wage of $20.00 - $22.00 with additional benefits including paid time off and a 401(k) match.#J-18808-Ljbffr The triangle apartment association
...These consults are including, but not limited to: High-risk teens: high-risk sexual behavior, drug use, gang/juvenile justice,... ...collaboration with a mission-driven integrated health care delivery model. An outstanding electronic medical record system that...
...Radiology, Social Services, and Pharmacy\n Utilize EPIC electronic health records for accurate and timely clinical documentation\n... ...GHR's dedication to competitive compensation, transparent communication, and a devoted team that genuinely cares about your career...