Pharmacy Claims Audit Supervisor - Remote US

Pharmacy Claims Audit Supervisor - Remote USIt takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.Summary: Supervises claims audit operations within Pharmacy Benefit Management (PBM) services. Ensures accurate adjudication of pharmacy claims while maintaining compliance with Medicaid requirements and operational performance standards. The Claims Audit Supervisor will have oversight of all FWA Audit Services including Concurrent Claims Review, Desk Audit and Field Audit.Your role in our mission:Lead and develop a team responsible for drug claims auditing and adjudication activitiesOversee claim audit workflows to ensure accuracy, timeliness, and compliance with PBM and Medicaid guidelinesMonitor performance metrics (productivity, quality, turnaround times) and implement process improvements to identify discrepanciesManage escalations and resolve complex claims issues involving members, providers, and pharmaciesPartner with internal teams to support system updates, audits, and ongoing claims operationsWork with state to present audit findings, develop new capabilities and manage appeal processesWhat we're looking for:Must hold an active Pharmacy Technician certification (CPhT), such as PTCB.5+ years of PBM, pharmacy operations, drug claims processing and audit operations experience2+ years of leadership or supervisory experienceStrong knowledge of identifying drug claim anomalies and pharmacy audit operationsStrong knowledge of pharmacy claims adjudication and Medicaid programsExperience with client communications and leading discussions with clientsExperience with operational reporting, KPIs, and process improvementWhat you should expect in this role:This is a remote work from home position. Leadership within a high-volume audit processing environment Collaboration with pharmacy, clinical, clients and IT teams Focus on accuracy, compliance, and operational efficiency Access to Gainwell's competitive benefits package for eligible employees, including medical, dental, vision, and 401(k) options in accordance with applicable eligibility guidelines.