Medical Audit Coordinator
About The Position
Provides guidance and strategic solutions to clients, focusing on optimizing pharmacy benefit programs to align with client goals. This role involves analyzing pharmacy claims data to identify cost drivers and savings opportunities, evaluating plan performance, and recommending improvements in areas such as plan design, formulary management, and utilization strategies. The consultant oversees Pharmacy Benefit Manager PBM selection, contract negotiation, and performance monitoring to ensure optimal pricing, service levels, and compliance with contractual obligations. Additionally, the role requires staying informed on industry trends, regulations, and emerging innovations to provide clients with cutting-edge solutions. Collaboration with internal teams, clients, and external partners is essential to deliver tailored strategies and maintain strong relationships, ensuring exceptional service delivery and client satisfaction.
Requirements
- University Degree or equivalent experience.
- Minimum 3 years of prior relevant experience.
- Strong knowledge of PBM operations, pharmacy claims data, and benefit design.
Nice To Haves
- Degree in healthcare, business, or pharmacy.
- Advanced analytical and problem-solving skills.
- Excellent written and verbal communication abilities.
- Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word).
- Strong project management and organizational skills.
- Ability to build and maintain strong client relationships.
Responsibilities
- Analyzing pharmacy claims data to identify cost drivers and savings opportunities.
- Evaluating plan performance and recommending improvements in areas such as plan design, formulary management, and utilization strategies.
- Overseeing Pharmacy Benefit Manager (PBM) selection, contract negotiation, and performance monitoring.
- Staying informed on industry trends, regulations, and emerging innovations.
- Collaborating with internal teams, clients, and external partners to deliver tailored strategies and maintain strong relationships.
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
Education Level
Associate degree
