PHARMACY AUDITOR - HYBRID

Green Shield Canada•Vancouver, BC

1d•$59,688 - $91,109•Hybrid

About The Position

Green Shield Canada (GSC) is a not-for-profit social enterprise that manages and administers benefit plan programs for nearly four million plan participants nationwide. As Canada's fourth largest health benefits provider, GSC is driven by its Purpose: to make it easier for people to live their healthiest lives. HBM+ is a business unit within GSC that provides customized white-label solutions for drug, dental, and extended health benefits. This role is crucial in ensuring compliance with Pharmacy Benefit Management (PBM) agreements and identifying cost-containment opportunities.

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.