Pharmacy Audit Data Analyst

Job Description:

• Perform audit testing of pharmacy claims data against contract terms, including pricing guarantees, administrative fees, and other contractual financial guarantees
• Write, troubleshoot, and optimize SQL queries in SQL Server Management Studio to analyze large pharmacy claims data sets
• Conduct rebate audits, including minimum rebate guarantee reconciliations, pass-through rebate testing, and rebate credit reviews
• Translate client and PBM contracts into audit rules by identifying guarantee terms, exclusions, and reporting requirements
• Build and maintain validation checks for data completeness and accuracy
• Design, document, and implement new audit tests as contract terms, regulations, and industry standards evolve
• Prepare client-ready exhibits and reports communicating audit findings and financial impact
• Research PBM responses and rebuttals and substantiate findings with claim-level detail
• Identify and communicate data limitations and unvalidated findings
• Communicate findings and data-driven recommendations to clients, PBMs, and internal consultants
• Respond to ad hoc data requests, claims data monitoring, data pulls, analyses, and exhibits
• Contribute to process improvements, automation, and internal audit tools and templates

Requirements:

• Bachelor's degree, preferably in math, health, science, or business discipline
• 2–6 years of relevant experience
• Experience in health insurance, pharmacy benefit design, or the PBM industry
• Working knowledge of pharmacy benefit concepts, including copays/coinsurance, AWP-based pricing, MAC, brand and generic classification, specialty drugs, formulary design, and rebates
• Ability to write and troubleshoot SQL queries; SQL Server Management Studio experience preferred
• Proficiency in Excel, Word, and PowerPoint, including work with large data sets
• Strong analytical, problem-solving, and documentation skills
• Ability to work independently and prioritize competing demands across multiple engagements
• Ability to explain technical terms, data, and analytic concepts clearly to non-technical audiences
• Exceptional attention to detail and accuracy
• Intellectual curiosity and willingness to question results
• Effective written and verbal communication skills
• Ownership, accountability, and critical thinking
• Legally authorized to work in the United States without immigration support or sponsorship now or in the future

Benefits:

• Medical, Dental and Vision coverage for employees, dependents, and domestic partners
• Employee Assistance Program (EAP)
• 401(k) plan with company matching and profit-sharing contributions
• Discretionary Bonus Program
• Flexible Spending Accounts (FSA)
• Paid Time Off (PTO); full-time employees accrue 15 days per year
• Minimum of 10 paid holidays per year
• Family Building Benefits, including adoption and fertility assistance
• 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 paid by Milliman
• Skills training and career development
• Learning and mentoring opportunities
• Employee Resource Groups (ERGs)