Hybrid Pharmacy Audit Lead - Strategic, Client-Facing

Marsh & McLennan Companies, Inc.

Atlanta (GA)

Hybrid

USD 103,000 - 205,000

Full time

14 days+

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Benefits offered by this job

Health & welfare benefits

Tuition assistance

401K retirement plans

Employee assistance programs

Job summary

Mercer is seeking a Health & Benefits Pharmacy Audit Lead Consultant to manage complex pharmacy claims and rebate audits, leveraging deep knowledge of PBM contracts and rebate economics. The role is hybrid with in-office requirements across US locations and will serve as the audit expert for clients.

You will mentor team members, shape audit methodology, and identify opportunities to expand services while driving innovation in tools and processes.

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.
Strong knowledge of PBM contract terms, pricing methodologies, and rebate structures.
Client-facing experience in a consulting environment.

Responsibilities

Lead end-to-end pharmacy claims and rebate audits for complex, high-visibility clients, identifying mispriced or misadjudicated claims.
Translate PBM contracts and rebate agreements into audit scope and sample selection.
Oversee claim and rebate review activity with consistent methodology.
Quantify financial impact and drive issues to resolution.
Present methodology, findings, and recommendations to clients.