Description

We are looking to recruit a full-time hardworking and enthusiastic Pharmacy Benefit Management (PBM) claims auditor to be part of our dynamic team. This is an
opportunity to join an established firm, with many marque clients, to use your talents to assist clients in managing their PBM claim costs. 

The ideal candidate will have substantial experience of completing PBM claim audits. Prior experience in claim audits and a strong understanding of healthcare data in a
team setting is a must to qualify.

This role is an important part of our overall client delivery and is responsible for performing supporting Pharmacy Audits (claims, rebates, pre-post implementation, etc.)
to validate payments of coverage, comply with all applicable contractual and custom plan designs.

Certain audits will also look to validate proper pharmacy rebate reimbursement per each contractual arrangement. This auditor will be responsible for setting realistic client
expectations and the ability to self-motivate, with multiple clients, without impact to accuracy and timeliness.

Salary will be competitive based on experience.

Qualifications:

• 3+ years PBM audit experience
• Client-first mentality
• Ability to work independently and in a team environment with the expectation of achieving goals
• Proficient in Excel, Microsoft PowerBI, PowerPoint
• Strong work ethic
• Superior time management and organizational skills

Requirements

Auditor Requirements:

• Manage and perform audits of pharmacy claim payment data with contractual
  requirements and plan specifications as assigned
• The ability to review and evaluate Administrative Services Agreement between
  the client and the PBM
• Ensure audit timeline is adhered to and deliver high level of service to clients
• Evaluate the results of the initial claim data tests and determine valid audit samples for review and response by the PBM
• Perform Pharmacy Rebate audits as assigned. (Occasional travel to the PBM is required;10-20% travel possible.)
• Maintain audit project work papers to support audit findings
• Participate in team meetings, conference calls, Zoom meetings, etc. remotely /locally with administrators and audit team as necessary
• Prepare and deliver audit findings to clients
• Assist with Claims Data Analysis and Quality Assurance as requested
• Prepare ad-hoc reporting and special projects as directed

Employee Benefits:

• 401K with 4% match
• Profit sharing
• Group Term Life Insurance
• Long Term Disability
• QSEHRA reimbursement for medical and dental
• PTO and Holiday pay