Pharmacy Benefit Auditor
Brown & Brown Insurance
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $90,000 - $105,000 per year
About the role
- Conducts Data Analysis for pharmacy benefit and contractual audits surrounding pharmacy claims.
- PBM audits can include, but are not limited to pricing, plan design, rebates, eligibility, CMS Data Validation, Fraud, Waste & Abuse and performance guarantee review.
- Includes gathering, implementing, executing, and finalizing audit rules and requirements from clients and PBMs into proprietary systems.
- Assists with review of PBM contract(s) and contribute suggestions for improvement, based on knowledge of industry
- Leverages the company’s reporting systems to conceptualize, design, and distribute both operational and analytical reports focused on pharmacy utilization and cost
- Assists with developing, documenting, and evaluating the business requirements associated with data flows to and from the PBM and other vendors
- Identifying issues and resolutions, and consulting management on potential solutions to facilitate critical decisions.
- Generate audit reports and consult with client on the findings.
- Works effectively on multiple client assignments or projects simultaneously
- Plan, schedule, and track project timelines, milestones, and deliverables.
Requirements
- Associate degree or higher (preferred)
- Direct PBM claims auditing experience within a PBM and/or Health Plan (preferred)
- Minimum of 3 to 5 years’ work experience in healthcare, health insurance fields pharmacy benefit management, with a focus on pharmacy claims processing and pharmacy benefits related activities
- Ability to build and maintain strong, collaborative working relationships with multiple business units across the company
- Strong communication skills (written and verbal)
- Ability to maintain a high level of confidentiality
- Proficient with MS Office Suite
Benefits
- Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
- Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
- Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services
- Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisauditingreportingbusiness requirements documentationdata flow evaluationissue identificationresolution consultingproject management
Soft Skills
collaborative working relationshipsstrong communicationconfidentiality
Certifications
Associate degree