Pharmacy Audit Data Analyst

Milliman•San Diego, CA

19h•Remote

About The Position

We are seeking a Pharmacy Audit Data Analyst to join our Pharmacy Benefits Audit team in our San Diego Health practice. In this role you will conduct data analysis on pharmacy claims, financial guarantees, and rebates, translating contract terms into data definitions, business rules, and testable audit logic that quantify how PBMs are performing against their contracts. Day to day, you will work hands-on in SQL with large claims data sets, build and monitor data quality checks, and produce the reports and analytic deliverables that clients and PBMs rely on to resolve disputes. This position may be performed remotely.

Requirements

Bachelor's degree, preferably in math, health, science, or business discipline
2-6 years of relevant experience that includes: Health insurance, Pharmacy benefit design, or PBM industry experience (PBM, health plan, insurance, consulting, or pharmacy operations)
Working knowledge of pharmacy benefit concepts, including copays/coinsurance, AWP-based pricing, MAC, brand and generic classification, specialty drugs, formulary design, and rebates
Demonstrated ability to write and troubleshoot SQL queries; experience with SQL Server Management Studio 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 in clear, plain language to non-technical audiences, including clients and vendors
Exceptional attention to detail and accuracy
Intellectual curiosity and a willingness to question results
Effective written and verbal communication skills
Ownership, accountability, and critical thinking
Individual(s) must be legally authorized to work in the United States without the need for immigration support or sponsorship from Milliman now or in the future.

Responsibilities

Perform audit testing of pharmacy claims data against contract terms, including discount and dispensing fee pricing guarantees, administrative fees, and other contractual financial guarantees
Write, troubleshoot, and optimize SQL queries in SQL Server Management Studio (SSMS) 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 subject to testing.
Build and maintain validation checks to confirm data completeness and accuracy before analysis begins.
Design, document, and implement new audit tests as contract terms, regulatory requirements, and industry standards evolve.
Prepare client-ready exhibits and reports that clearly communicate audit findings and financial impact.
Support the resolution process by researching PBM responses and rebuttals and substantiating findings with claim-level detail.
Clearly identify and communicate data limitations and any findings that cannot be validated with available information.
Communicate audit findings and data-driven recommendations directly to clients, PBMs, and internal consultants through clear reports and exhibits at key points in the audit lifecycle.
Respond to ad hoc data requests, including claims data monitoring and one-off data pulls, analyses, or exhibits requested by clients and consultants.
Contribute to process improvements, automation, and the development of internal audit tools and templates.

Benefits

Medical, Dental and Vision – Coverage for employees, dependents, and domestic partners.
Employee Assistance Program (EAP) – Confidential support for personal and work-related challenges.
401(k) Plan – Includes a company matching program and profit-sharing contributions.
Discretionary Bonus Program – Recognizing employee contributions.
Flexible Spending Accounts (FSA) – Pre-tax savings for dependent care, transportation, and eligible medical expenses.
Paid Time Off (PTO) – Begins accruing on the first day of work. Full-time employees accrue 15 days per year, and employees working less than full-time accrue PTO on a prorated basis.
Holidays – A minimum of 10 paid holidays per year.
Family Building Benefits – Includes adoption and fertility assistance.
Paid Parental Leave – 11 weeks of paid leave for employees who meet eligibility criteria.
Life Insurance & AD&D – 100% of premiums covered by Milliman.
Short-Term and Long-Term Disability – Fully paid by Milliman.