A national health plan with 4 million members needed help monitoring its Pharmacy Benefit Manager activity due to limited internal audit resources. Conduent implemented pharmacy audit solutions using advanced analytics to detect emerging claim patterns, a proven audit tool to identify high-recovery claim types, and on-site visits to high-volume pharmacies. Unlike rules-based systems, this approach uncovered nearly undetectable issues while also educating pharmacies on best practices. With nationwide coverage by Conduent employees, the program delivered $33 million in recoveries over three years, identifying 16 percent of claims as discrepant and recouping 3 percent of total pharmacy spend.

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