Pharmacy Audit Engineer Analyst

Brown & Brown Insurance•Remote - Wisconsin, WI

2d•$75,000 - $90,000

About The Position

Brown & Brown / Remedy Analytics is seeking an experienced Pharmacy Audit Engineer/Analyst to complete pharmacy claims audits and assess compliance with PBM contracts. The role includes facilitating calls with PBMs; obtaining, loading, and quality-checking audit data; reconciling data; running and analyzing Oracle output reports; conducting ad hoc analyses; reviewing PBM contracts; preparing audit support documentation; and working with the client support team on PBM and client deliverables. The role uses ad hoc SQL automation and a customized framework to complete projects, and develops, prioritizes, and conducts financial and operational audits evaluating PBM contract effectiveness, controls, and financial-information accuracy. The successful candidate will plan and carry out multiple audits with different deadlines, analyze master files and system changes, improve audit automation, follow up on audit observations and remediation, draft audit reports, respond to prioritized analytics requests, and identify opportunities to improve operational efficiency. The role requires compliance with applicable regulatory requirements, policies, procedures, HIPAA requirements, and leading practices. A bachelor’s degree in data science, analytics, or a similar discipline is listed under Licenses & Certifications. The position is full-time, with an annual pay range of $75,000–$90,000. The posting describes teammate benefits including health, financial, mental-health and wellness benefits, paid time off, holidays, and partner discounts; eligibility and offerings may vary.

Requirements

Working knowledge of SQL, including joins, aggregations, filtering, and subqueries or CTEs.
Familiarity with window functions and running totals, or ability to learn them quickly.
Experience loading or importing data into a database using Toad, SQL Developer, or a similar tool.
Experience building reports or dashboards in Power BI or another BI tool.
Ability to check query results for accuracy and maintain existing queries.
Relevant experience demonstrating problem-solving, financial acumen, and analytical output.
Proficiency in Microsoft Office applications, including Excel, Word, PowerPoint, and Power BI.
Ability to work in a fast-paced environment, respond to oversight, follow instructions, anticipate needs, and develop efficiencies for repeat tasks.
Excellent verbal and written communication skills.
Experience developing and maintaining collaborative relationships with clients and internal stakeholders.
Strong project ownership and ability to manage high project volume.
Strong problem-solving, critical-thinking, and analytical skills, with ability to work in a cross-functional team.
Ability to adapt to changing project direction and priorities in a deadline-oriented environment.
Bachelor’s degree in data science, analytics, or a similar discipline.

Nice To Haves

Experience in project management.
Experience with version control such as Git or Bitbucket.
Familiarity with visualization tools; Power BI or SSRS preferred.
Proficiency in Python, including pandas, NumPy, and general data manipulation techniques.
Familiarity with low-code or no-code solutions.
Experience working with pharmacy and/or medical claims data.
Pharmacy claims audit experience or knowledge of pharmacy claims data.
Basic understanding of how data is organized for reporting, such as fact and dimension tables.
Exposure to Toad for Oracle or a similar application.
Experience with Oracle.

Responsibilities

Plan and develop audit approaches for assigned projects consistent with Remedy internal Audit Standards.
Manage multiple audits with differing deadlines while maintaining attention to detail and meeting timelines.
Analyze and perform quality checks on master files, profiles, and table changes to ensure changes are accounted for.
Improve audit automation transforms based on findings, industry changes, and technology updates.
Track open audit observations and follow up to assess remediation with PBMs and the Remedy account team.
Draft audit reports communicating analysis results to the Remedy account team.
Perform prioritized daily or weekly ad hoc data analytics requests.
Re-evaluate system functionality to identify opportunities to improve operational efficiency.
Comply with regulatory requirements, policies, and procedures, including HIPAA requirements and leading practices.
Facilitate calls with PBMs and obtain, load, validate, and reconcile claims audit data.
Run and analyze Oracle output reports and conduct ad hoc analysis.
Review PBM contracts and prepare audit support documentation.
Work with the client support team to develop PBM and client deliverables.
Use SQL automation and a customized framework to complete projects and conduct financial and operational audits.