Pharmacy Audit Data Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct audit testing of pharmacy claims data in relation to contract stipulations, encompassing pricing assurances, administrative fees, and other financial commitments outlined in contracts.

• Develop, troubleshoot, and enhance SQL queries using SQL Server Management Studio to examine extensive pharmacy claims datasets.

• Execute rebate audits, which include reconciling minimum rebate guarantees, conducting pass-through rebate tests, and reviewing rebate credits.

• Convert client and PBM contracts into audit metrics by pinpointing guarantee provisions, exclusions, and reporting obligations.

• Establish and sustain validation checks to ensure data completeness and precision.

• Create, document, and execute new audit procedures as contract stipulations, regulations, and industry benchmarks progress.

• Generate client-ready exhibits and reports that convey audit results and their financial implications.

• Investigate PBM responses and counterarguments, supporting findings with detailed claim-level analysis.

• Recognize and articulate data limitations and unverified outcomes.

• Relay findings and data-informed recommendations to clients, PBMs, and internal consultants.

• Address ad hoc data inquiries, monitor claims data, and perform data pulls, analyses, and exhibit preparations.

• Engage in process enhancements, automation, and the development of internal audit tools and templates.

⛳️ Requirements

• Bachelor's degree, ideally in mathematics, health, science, or a business-related field.

• 2–6 years of pertinent experience.

• Background in health insurance, pharmacy benefit design, or the PBM sector.

• Familiarity with pharmacy benefit principles, including copays/coinsurance, AWP-based pricing, MAC, brand and generic classifications, specialty medications, formulary design, and rebates.

• Proficient in writing and troubleshooting SQL queries; experience with SQL Server Management Studio is preferred.

• Competent in Excel, Word, and PowerPoint, particularly with large datasets.

• Strong analytical and problem-solving abilities, along with effective documentation skills.

• Capability to work autonomously and manage conflicting priorities across multiple projects.

• Proficient in articulating technical terminology, data, and analytical concepts effectively to non-technical audiences.

• Outstanding attention to detail and accuracy.

• Intellectual curiosity and a readiness to question findings.

• Strong written and verbal communication skills.

• Demonstrated ownership, accountability, and critical thinking abilities.

• Legally authorized to work in the United States without current or future immigration support or sponsorship.

🏝️ Benefits

• Comprehensive Medical, Dental, and Vision coverage for employees, dependents, and domestic partners.

• Employee Assistance Program (EAP).

• 401(k) plan featuring company matching and profit-sharing contributions.

• Discretionary Bonus Program.

• Flexible Spending Accounts (FSA).

• Paid Time Off (PTO); full-time employees earn 15 days annually.

• At least 10 paid holidays each year.

• Family Building Benefits, including support for adoption and fertility.

• 11 weeks of paid parental leave for eligible employees.

• Life Insurance & AD&D; 100% of premiums covered by Milliman.

• Short-Term and Long-Term Disability; fully funded by Milliman.

• Opportunities for skills training and career development.

• Learning and mentoring programs available.

• Employee Resource Groups (ERGs).