Auditor of Pharmacy Benefit Management - Remote
About The Position
Responsible for leading complex pharmacy claim audits, ensuring compliance with client-specific requirements, and delivering advanced data analysis to identify trends, risks, and opportunities for improvement. This role involves managing high-risk audits, investigating fraud or discrepancies, and presenting comprehensive reports with actionable recommendations. The Auditor provides strategic insights through advanced data analysis, predictive modeling, and the development of sophisticated dashboards to support client decision-making and cost-saving initiatives. Acting as a trusted advisor, this role manages senior-level client relationships, leads discussions on audit findings, and collaborates on customized strategies to optimize pharmacy operations. Additionally, the position includes reviewing deliverables, and driving team projects to enhance audit processes and tools. With expertise in regulatory compliance, including HIPAA, the Auditor ensures adherence to industry standards and provides guidance to clients and internal teams. This role also focuses on continuous improvement, innovation, and strategic initiatives to enhance client satisfaction, operational efficiency, and risk management.
Requirements
- B.S. degree
- 3-5 years experience
- Experience as a Pharmacy Tech
- Project management experience within PBM
- Expertise in regulatory compliance, including HIPAA
Responsibilities
- Leading complex pharmacy claim audits
- Ensuring compliance with client-specific requirements
- Delivering advanced data analysis to identify trends, risks, and opportunities for improvement
- Managing high-risk audits
- Investigating fraud or discrepancies
- Presenting comprehensive reports with actionable recommendations
- Providing strategic insights through advanced data analysis, predictive modeling, and the development of sophisticated dashboards
- Managing senior-level client relationships
- Leading discussions on audit findings
- Collaborating on customized strategies to optimize pharmacy operations
- Reviewing deliverables
- Driving team projects to enhance audit processes and tools
- Ensuring adherence to industry standards and providing guidance to clients and internal teams
- Focusing on continuous improvement, innovation, and strategic initiatives
Benefits
- Medical/dental/vision plans
- Life and accident insurance
- 401(K) and Roth options
- Tax-advantaged accounts (HSA, FSA)
- Educational expense reimbursement
- Paid parental leave
- Digital mental health services (Talkspace)
- Flexible work hours
- Training programs
- Gallagher Thrive program
- Charitable matching gift program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
