Senior Client Audit Engineer – Pharmacy

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

📋 Description

• Conduct pharmacy claims audits to ensure adherence to PBM contracts.

• Coordinate calls with PBMs to gather claims audit information.

• Execute data loading, quality assessments, and reconciliation tasks.

• Generate and analyze Oracle output reports while conducting ad-hoc analyses.

• Examine PBM contracts and prepare necessary audit support documentation.

• Collaborate with the client support team to produce deliverables for PBMs and clients.

• Strategize and formulate audit methodologies for assigned projects in accordance with Remedy internal Audit Standards.

• Manage multiple audits concurrently, each with distinct deadlines.

• Evaluate and ensure the quality of master files, profiles, and changes to tables.

• Sustain and enhance audit automation transformations.

• Monitor open audit observations and follow up on remediation actions.

• Compose audit reports that convey analytical findings.

• Handle daily and weekly ad-hoc data analytics requests.

• Reassess system functionalities and pinpoint opportunities for operational efficiencies.

• Create tools, templates, and reports to support process enhancement initiatives.

• Assist in the training of new internal audit personnel.

• Adhere to regulatory compliance standards, policies, procedures, HIPAA mandates, and best practices.

• Perform quality reviews for junior auditors.

• Develop audit automation transformations for new PBMs.

• Collaborate with engineering and product teams to prototype solutions and validate data pipelines using Python and SQL.

⛳️ Requirements

• Bachelor's degree in computer science, engineering, or a related field with a focus on analytical skills.

• High proficiency in creating and managing database tables, ETL processes, complex Oracle/SQL queries, and maintaining code.

• Understanding of dimensional modeling and experience in manipulating models, as well as developing and executing business logic.

• Relevant experience showcasing problem-solving skills, financial insight, and analytical output.

• Ability to excel in a dynamic environment, respond promptly to oversight, follow instructions meticulously, anticipate needs, and streamline repetitive tasks.

• Strong verbal and written communication abilities.

• Experience in building and maintaining effective, collaborative relationships with clients and internal stakeholders.

• Solid project ownership skills with the capability to manage a high volume of projects efficiently.

• Exceptional problem-solving, critical thinking, and analytical skills with experience working in cross-functional teams.

• Flexibility to adapt to changes in direction and priorities in a project-driven and deadline-focused atmosphere.

• 3-5 years of experience with pharmacy claims data (mandatory).

• Experience in pharmacy claims auditing and/or familiarity with pharmacy claims data (mandatory).

• Project management experience (preferred but not essential).

• Familiarity with version control systems (git, bitbucket) (preferred but not essential).

• Knowledge of visualization tools (PowerBI/SSRS preferred) (preferred but not essential).

• Proficiency in Python (pandas, NumPy, general data manipulation techniques) (preferred but not essential).

• Awareness of low code to no code solutions (preferred but not essential).

🏝️ Benefits

• Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance.

• Employee Stock Purchase Plan (ESPP).

• 401(k) plan.

• Student Loan Assistance.

• Tuition Reimbursement.

• Complimentary Mental Health & Enhanced Advocacy Services.

• Paid Time Off.

• Holiday pay.

• Discounts from preferred partners.