Hybrid Pharmacy Audit Lead & PBM Expert
Mercer
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Job summary
Mercer is seeking a Pharmacy Audit Lead Consultant to lead complex pharmacy claims and rebate audits, applying deep expertise in PBM contracts and rebate economics. You will act as the primary consultant for clients, partner with internal teams, and drive growth within the Health & Benefits practice.
The role requires a Bachelor's degree in a relevant field and 8+ years of experience in pharmacy claims auditing or PBM operations.
Qualifications
- Bachelor's degree in pharmacy, healthcare, business, finance, analytics, or related field.
- 8+ years of experience in pharmacy claims auditing, PBM operations, or health plan administration.
- Strong knowledge of PBM contracts, pricing methodologies, and rebate structures.
- Client-facing experience in a consulting environment.
Responsibilities
- Lead end-to-end pharmacy claims and rebate audits for high-visibility clients.
- Translate contracts, pricing guarantees, formulary terms and rebate agreements into audit scope.
- Oversee claim and rebate review activity with consistent methodology and clear documentation.
- Quantify financial impact, evaluate vendor responses, and drive to resolution.
- Serve as primary client contact and present findings clearly.
- Mentor team members and drive innovations in audit methodology.
Education
Job description
Mercer is seeking a Pharmacy Audit Lead Consultant to lead complex pharmacy claims and rebate audits, applying deep expertise in PBM contracts and rebate economics. You will act as the primary consultant for clients, partner with internal teams, and drive growth within the Health & Benefits practice.
The role requires a Bachelor's degree in a relevant field and 8+ years of experience in pharmacy claims auditing or PBM operations.
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