Experienced Pharmacy Special Investigations Professional – Remote Opportunity for Fraud Detection and Prevention Expert

Introduction to Workwarp and the Role

Workwarp, a leading company in the healthcare industry, is seeking an experienced and skilled Pharmacy Special Investigations Professional to join our team of experts in fraud detection and prevention. As a Pharmacy Special Investigations Professional, you will play a critical role in conducting comprehensive investigations of reported, alleged, or suspected fraud, ensuring the integrity of our pharmacy services and protecting our members from fraudulent activities. If you have a passion for investigative work, a strong analytical mind, and excellent communication skills, we encourage you to apply for this exciting opportunity.

Role Overview

The Pharmacy Special Investigations Professional will be responsible for conducting thorough investigations of fraudulent and abusive practices, analyzing data to identify potential fraud trends, and performing on-site audits of provider records to ensure appropriate billing practices. You will also establish and maintain working relationships with governmental law enforcement and regulatory agencies, collaborating with them to prevent and detect fraud. This is a remote opportunity, allowing you to work from the comfort of your own home, with occasional travel required (less than 5% within the US).

Key Responsibilities

• Conduct comprehensive investigations of reported, alleged, or suspected fraud, including thorough documentation of investigating activities
• Analyze data to identify potential fraud trends and develop strategies to prevent and detect fraud
• Perform on-site audits of provider records to ensure appropriate billing practices
• Establish and maintain working relationships with governmental law enforcement and regulatory agencies
• Collaborate with internal stakeholders to develop and implement effective fraud prevention and detection strategies
• Stay up-to-date with industry trends, regulatory requirements, and best practices in fraud detection and prevention

Essential Qualifications

To be successful in this role, you will need:

• A Bachelor's degree in a related field (e.g., pharmacy, healthcare, law enforcement)
• Minimum 2 years of experience in pharmacy fraud investigations, pharmacy auditing, or pharmacy technology
• Advanced knowledge of Microsoft Office Suite (Word, Excel, Access)
• An inquisitive nature with the ability to analyze data and metrics
• Strong organizational, interpersonal, and communication skills
• Ability to travel less than 5% within the US (once travel restrictions are lifted)
• Full COVID vaccination or willingness to undergo weekly COVID testing and wear a face covering while at work

Preferred Qualifications

While not required, the following qualifications are preferred:

• Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
• Understanding of the healthcare industry, claims processing, and investigative process development
• Government or corporate healthcare fraud investigative experience

Skills and Competencies

To excel in this role, you will need:

• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong organizational and time management skills
• Ability to maintain confidentiality and handle sensitive information

Career Growth Opportunities and Learning Benefits

At Workwarp, we are committed to the growth and development of our employees. As a Pharmacy Special Investigations Professional, you will have access to:

• Professional development opportunities, including training and education programs
• Continued education and certification programs
• Opportunities for career advancement and growth within the company
• A collaborative and supportive work environment

Work Environment and Company Culture

At Workwarp, we value our employees and strive to create a positive and supportive work environment. As a remote employee, you will have the flexibility to work from home, with occasional travel required. Our company culture is built on the principles of integrity, respect, and excellence, and we are committed to putting the health and safety of our members, patients, associates, and communities first.

Compensation, Perks, and Benefits

We offer a competitive salary and benefits package, including:

• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
• Go365 perks for well-being

Conclusion

If you are a motivated and experienced professional looking for a challenging and rewarding role in fraud detection and prevention, we encourage you to apply for this exciting opportunity. As a Pharmacy Special Investigations Professional at Workwarp, you will have the chance to make a real difference in the lives of our members and patients, while also growing and developing your skills and career. Apply now and join our team of experts in the fight against fraud and abuse.

How to Apply

Ready to join us? The first step is easy. Click apply now and we'll be in touch soon! Please note that as part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.