PHARMACY AUDITOR - HYBRID

Green Shield Canada•Vancouver, BC

1d•$59,688 - $91,109•Hybrid

About The Position

GreenShield is a not-for-profit social enterprise dedicated to improving the health of all Canadians. We are seeking a Pharmacy Auditor to join our team and contribute to our mission. This role involves conducting audits of pharmacy providers to ensure compliance with agreements, reviewing claims for accuracy and regulatory adherence, and analyzing data to identify trends and cost-saving opportunities. The ideal candidate will have a strong understanding of pharmacy operations and claims processing, excellent analytical and communication skills, and a commitment to integrity and confidentiality.

Requirements

Experience in pharmacy auditing, drug claim processing, PBM operations, healthcare analytics, or related fields.
Knowledge of pharmacy claims, dispensing practices, regulatory requirements, and drug pricing structures.
Proficiency with Excel, SQL, or other analytical tools used for data review and reporting.
Strong written communication skills, including the ability to prepare clear and comprehensive audit reports.
Ability to manage multiple audits simultaneously and meet established deadlines.
High level of integrity with strict adherence to confidentiality and compliance standards.
Strong interpersonal skills with the ability to communicate effectively with internal and external stakeholders at all levels, both verbally and in writing.
Analytical mindset with experience interpreting complex data structures, identifying business problems, and supporting process-improvement solutions.
Demonstrated ability to meet objectives and milestones independently.
Highly organized, with the ability to manage multiple audits simultaneously in a fast-paced environment.
Ability to travel within Canada as required.
Proficiency in English is required.

Nice To Haves

Certified Pharmacy Technician (CPhT) or equivalent pharmacy experience
Bilingual (English and French) - Asset.
Experience with pharmacy claims systems
A Certified Fraud Examiner (CFE) certificate.

Responsibilities

Conduct on-site and desk audits of pharmacy providers to verify compliance with Pharmacy Benefit Management (PBM) agreements.
Review pharmacy claims and dispensing records for accuracy and regulatory adherence.
Analyze large datasets to identify trends, anomalies, and potential risk indicators.
Research and report on health benefit utilization trends; develop provider profiling criteria.
Identify cost-containment opportunities and support financial recovery efforts.
Prepare audit reports outlining findings, financial impact, and corrective actions.
Communicate findings to internal teams and pharmacy providers; support remediation efforts.
Serve as a subject-matter expert on pharmacy operations, claims adjudication, and PBM reimbursement.