Hybrid Pharmacy Audit Lead – PBM & Rebates Expert

Mercer; San Francisco (CA); Hybrid; USD 103,000 - 205,000; Full time

Job summary

Mercer is seeking a Pharmacy Audit Lead Consultant to lead complex pharmacy claims and rebate audits from planning through final report. You will serve as the primary consultant and pharmacy audit SME for clients, partnering with internal experts to deliver defensible findings while driving growth across the practice.

The role requires deep expertise in pharmacy benefits, PBM contracts, rebate economics, and strong client-facing presentation skills.

Qualifications

• Bachelor's degree in pharmacy, healthcare, business, finance, analytics, or related field.
• Minimum of 8 years of experience in pharmacy claims auditing, PBM operations, pharmacy benefit consulting, or health plan administration.
• Excellent knowledge of pharmacy benefits, claims adjudication, formulary administration, and specialty pharmacy.

Responsibilities

• Lead end-to-end pharmacy claims and rebate audits for complex, high-visibility clients, applying deep working knowledge of pharmacy claims data and every claim field and component to identify mispriced, misadjudicated, or non-contracted payments.
• Translate PBM contracts, pricing guarantees, formulary terms, and rebate agreements into audit scope and defensible sample selection using analytics/SaaS tools.
• Oversee claim and rebate review activity, ensuring consistent methodology, sound judgment, and clear documentation across the team.
• Quantify financial impact, evaluate vendor responses, and drive issues to final resolution.
• Serve as primary client contact, presenting methodology, findings, and recommendations with clarity and confidence.
• Partner with internal consultants as the pharmacy audit subject‑matter expert.
• Identify opportunities to expand services and support new business development, while driving innovation in audit methodology, tools, and practice capabilities.
• Mentor team members and serve as a key quality checkpoint for audit work.
• Thrive and be motivated by an environment that embraces AI and technology‑enabled tools.

Skills

Pharmacy audits

Data analysis

PBM contracts

Client engagement

Claims adjudication

Leadership

Education

Bachelor's degree in pharmacy or related field

Tools

Analytics tools

Job description

Mercer is seeking a Pharmacy Audit Lead Consultant to lead complex pharmacy claims and rebate audits from planning through final report. You will serve as the primary consultant and pharmacy audit SME for clients, partnering with internal experts to deliver defensible findings while driving growth across the practice.

The role requires deep expertise in pharmacy benefits, PBM contracts, rebate economics, and strong client-facing presentation skills.