Conduent is looking for Pharmacy Claims Auditor CPhT in Fair Oaks, TX.
This local job opportunity with ID 3939537923 is live since 2026-11-03 17:21:59.
Conduent seeks a Pharmacy Claims Auditor CPhT to review high-volume pharmacy claims for accuracy, compliance, and potential fraud, waste, or abuse. You will validate coding, pricing, eligibility, and formulary rules, investigate discrepancies, and document findings to support recoveries and client reporting. Partnering with operations, pharmacy, and client teams, you’ll identify trends, recommend process improvements, and support audit readiness. You’ll work in a collaborative, data-driven culture with opportunities to build expertise in digital platforms, automation, and large-scale claims operations. Audit pharmacy claims for accuracy, completeness, and compliance with plan rules and regulations. Identify and investigate billing anomalies, overpayments, and potential fraud, waste, or abuse. Verify eligibility, pricing, formulary, NDC, and DAW coding across claim populations. Document audit findings, prepare summaries, and support recovery and corrective actions. Collaborate with internal teams to resolve issues and improve claim quality and processes. Use data and reporting tools to analyze trends and support client and regulatory reporting. Support readiness for client, regulatory, and internal quality audits. Recommend process and control improvements to enhance claim integrity and efficiency. Pharmacy claims auditing Pharmacy benefit management (PBM) systems Data analysis and reporting (Excel or BI tools) Knowledge of NDC, DAW, and formulary rules Understanding of Medicare/Medicaid pharmacy regulations Fraud, waste, and abuse detection Prior authorization and rejected claim review Quality assurance and compliance documentation Process improvement and root cause analysis Technical proficiency with claim processing platforms Medical Insurance Dental Insurance Vision Insurance Life Insurance 401k Active Certified Pharmacy Technician (CPhT) credential State pharmacy technician registration or license (as applicable) Familiarity with Medicare/Medicaid and commercial pharmacy benefit rules Knowledge of pharmacy billing and reimbursement standards (NCPDP, PBM workflows)5c143e31-5e48-4549-b638-05792d185386
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