For Employers

Gainwell Technologies LLC

Pharmacy Claims Audit Supervisor - Remote US

Posted an hour ago
$47300 - $67600 per year
5-10 years experience
Apply Now

Please mention DailyRemote when applying

?/100
Resume Match Score

Match your resume skills with our AI powered skill match!

Get professional review
AI Summary

The supervisor will lead a team responsible for drug claims auditing and adjudication while ensuring compliance with PBM and Medicaid guidelines. They will also manage audit workflows, monitor performance metrics, and partner with internal teams to resolve complex claims issues.

It 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 activities
  • Oversee claim audit workflows to ensure accuracy, timeliness, and compliance with PBM and Medicaid guidelines
  • Monitor performance metrics (productivity, quality, turnaround times) and implement process improvements to identify discrepancies.
  • Manage escalations and resolve complex claims issues involving members, providers, and pharmacies
  • Partner with internal teams to support system updates, audits, and ongoing claims operations
  • Work with state to present audit findings, develop new capabilities and manage appeal processes

What we're looking for

  • Must hold an active Pharmacy Technician certificatioin (CPhT), such as PTCB.
  • 5+ years of PBM, pharmacy operations, drug claims processing and audit operations experience
  • 2+ years of leadership or supervisory experience
  • Strong knowledge of identifying drug claim anomalies and pharmacy audit operations
  • Strong knowledge of pharmacy claims adjudication and Medicaid programs
  • Experience with client communications and leading discussions with clients
  • Experience with operational reporting, KPIs, and process improvement

What 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.

 

#LI-REMOTE

#LI-JT1

#LI-CM1

 

The pay range for this position is $47,300.00 - $67,600.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

 

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

 

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Automatically Apply to the Best Remote Jobs

Stop the endless job search. Our AI finds and applies to the best jobs for you.

Try it Now
Keep looking

Similar Jobs

See all Remote Legal jobs →

Paralegal

Freelance United States $75 per hour Legal

Customs Compliance Specialist

Full Time United States Legal

Corporate Counsel

Full Time United States $164K - $250K per year Legal

Commercial Insurance Consultant, Claims Insights- Remote

Full Time United States $122K - $164K per year Legal

Litigation Operations Consultant, Projects & Technology – Remote

Full Time United States $110K - $147K per year Legal

Associate Counsel, Contracts

Full Time United Kingdom Legal
Apply Now

Personalize your Remote Job Search in 3 Easy Steps!

Discover remote opportunities in Legal

Answer easy questions

Answer easy questions

200,000+ jobs across 15+ categories

Get your best job matches

Get your best job matches

Only hand-screened, legit jobs

Find a remote job faster

Find a remote job faster

No ads, scams, or junk

I was the first applicant for a remote marketing position that got listed on the company website the same day I applied. Had an interview within 48 hours!”

Sarah J. — Sarah J. · Marketing Manager ★★★★★ Verified