Case Development Specialist

2+ years of experience in healthcare, PBM, or insurance (SIU or audit experience preferred).

Strong organizational and data management skills with attention to detail.

Proficiency with case management systems and Microsoft Office and Excel.

Ability to handle confidential and sensitive information.

Nice to have:

The Case Development Specialist supports both the Pharmacy Audit and the FWA investigation teams by ensuring that all cases are accurately initiated, risk-assessed, and prioritized according to established guidelines. This role serves as the operation backbone for the case intake, triage, and tracking process, verifying data integrity, performing initial analysis, and supporting case documentation from intake through closure.

The Specialist ensures smooth operational flow from case intake through closure, maintaining organized files, supporting data validation, and preparing materials needed for auditors, investigators, and reporting requirements.

Enter and track new cases for both Pharmacy Audit and FWA Investigation teams.

Complete and document risk scores prior to case opening to determine priority level.

Review incoming referrals for completeness and data accuracy.