Pharmacy Audit Data Analyst

Milliman, Inc; San Diego (CA); Remote; USD 59,000 - 109,000; Full time

Benefits offered by this job

Medical, Dental & Vision

401(k) Plan

PTO & holidays

Life Insurance & AD&D

Discretionary Bonus

FSA

Job summary

Milliman, Inc. in San Diego is seeking a Pharmacy Audit Data Analyst to analyze pharmacy claims, rebates, and guarantees, translating contract terms into data definitions and audit logic. You will work hands-on in SQL with large data sets, build data quality checks, and prepare client-ready exhibits and reports.

This role may be performed remotely within the United States; join the Pharmacy Benefits Audit team within the San Diego Health practice.

Qualifications

• Bachelor's degree required or equivalent in math, health, science, or business.
• 2-6 years of relevant experience (PBM/health plan/consulting pharmacy operations).
• Experience writing and troubleshooting SQL queries; SSMS preferred.
• Proficiency in Excel, Word, and PowerPoint with large data sets.

Responsibilities

• Perform audit testing of pharmacy claims data against contract terms, including discount and dispensing fee pricing guarantees and other financial guarantees.
• Write, troubleshoot, and optimize SQL queries in SSMS to analyze large pharmacy claims data sets.
• Conduct rebate audits, including minimum rebate guarantee reconciliations and pass-through rebate testing.
• Translate client and PBM contracts into audit rules by identifying guarantee terms and reporting requirements.

Skills

SQL querying

Data analysis

Excel/Office

Communication

Independent work

Education

Bachelor's degree (math/health/science/business)

Tools

SQL Server Management Studio (SSMS)

SQL

Job description

We are seeking a Pharmacy Audit Data Analyst to join our Pharmacy Benefits Audit team in our San Diego Health practice. In this role you will conduct data analysis on pharmacy claims, financial guarantees, and rebates, translating contract terms into data definitions, business rules, and testable audit logic that quantify how PBMs are performing against their contracts. Day to day, you will work hands-on in SQL with large claims data sets, build and monitor data quality checks, and produce the reports and analytic deliverables that clients and PBMs rely on to resolve disputes. This position may be performed remotely.

Who We Are

Independent for over 75 years, Milliman delivers market-leading services and solutions to clients worldwide. Today, we are helping companies take on some of the world's most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics, and business transformation.

Milliman invests in skills training and career development and gives all employees access to a variety of learning and mentoring opportunities. Our growing number of Milliman Employee Resource Groups (ERG's) are employee-led communities that influence policy decisions, develop future leaders, and amplify the voices of their constituents. We encourage our employees to give back to their varied professions, including leadership in professional organizations. Please visit our website (https://www.milliman.com/en/social-impact) to learn more about Milliman's commitments to our people, inclusion, and sustainability.

Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance.

What You Will Do

In this role, you will:

• Perform audit testing of pharmacy claims data against contract terms, including discount and dispensing fee pricing guarantees, administrative fees, and other contractual financial guarantees
• Write, troubleshoot, and optimize SQL queries in SQL Server Management Studio (SSMS) to analyze large pharmacy claims data sets.
• Conduct rebate audits, including minimum rebate guarantee reconciliations, pass-through rebate testing, and rebate credit reviews.
• Translate client and PBM contracts into audit rules by identifying guarantee terms, exclusions, and reporting requirements subject to testing.
• Build and maintain validation checks to confirm data completeness and accuracy before analysis begins.
• Design, document, and implement new audit tests as contract terms, regulatory requirements, and industry standards evolve.
• Prepare client-ready exhibits and reports that clearly communicate audit findings and financial impact.
• Support the resolution process by researching PBM responses and rebuttals and substantiating findings with claim-level detail.
• Clearly identify and communicate data limitations and any findings that cannot be validated with available information.
• Communicate audit findings and data-driven recommendations directly to clients, PBMs, and internal consultants through clear reports and exhibits at key points in the audit lifecycle.
• Respond to ad hoc data requests, including claims data monitoring and one-off data pulls, analyses, or exhibits requested by clients and consultants.
• Contribute to process improvements, automation, and the development of internal audit tools and templates.

What We Are Looking For

Professional Qualifications

• Bachelor's degree, preferably in math, health, science, or business discipline
• 2-6 years of relevant experience that includes:
• Health insurance, Pharmacy benefit design, or PBM industry experience (PBM, health plan, insurance, consulting, or pharmacy operations)
• Working knowledge of pharmacy benefit concepts, including copays/coinsurance, AWP-based pricing, MAC, brand and generic classification, specialty drugs, formulary design, and rebates
• Demonstrated ability to write and troubleshoot SQL queries; experience with SQL Server Management Studio preferred
• Proficiency in Excel, Word, and PowerPoint, including work with large data sets
• Strong analytical, problem-solving, and documentation skills
• Ability to work independently and prioritize competing demands across multiple engagements

Personal Qualifications

• Ability to explain technical terms, data, and analytic concepts in clear, plain language to non-technical audiences, including clients and vendors
• Exceptional attention to detail and accuracy
• Intellectual curiosity and a willingness to question results
• Effective written and verbal communication skills
• Ownership, accountability, and critical thinking

Required

Individual(s) must be legally authorized to work in the United States without the need for immigration support or sponsorship from Milliman now or in future.

The Team

The San Diego Health practice includes employees with diverse areas of experience and expertise in the pharmacy space. Current employees include those that have worked as actuaries, PBM analysts/consultants, pharmacists, and pharmacy technicians.

Location

The expected application deadline for this job is October 22, 2026.

This role is based out of the Milliman office in San Diego, CA, but candidates hired into this role may work remotely anywhere in the US or onsite if they prefer.

Compensation

The overall range for this role is $59,200 - $109,020. For candidates residing in:

• Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, New York City, Pennsylvania, Virginia, Washington, or the District of Columbia the range is $68,080 - $109,020.
• All other locations the range is $59,200 - $94,800.

A combination of factors will be considered, including, but not limited to, education, relevant work experience, qualifications, skills, certifications, etc.

Benefits

We offer a comprehensive benefits package designed to support employees' health, financial security, and well-being. Benefits include:

• Medical, Dental and Vision - Coverage for employees, dependents, and domestic partners.
• Employee Assistance Program (EAP) - Confidential support for personal and work-related challenges.
• 401(k) Plan - Includes a company matching program and profit-sharing contributions.
• Discretionary Bonus Program - Recognizing employee contributions.
• Flexible Spending Accounts (FSA) - Pre-tax savings for dependent care, transportation, and eligible medical expenses.
• Paid Time Off (PTO) - Begins accruing on the first day of work. Full-time employees accrue 15 days per year, and employees working less than full-time accrue PTO on a prorated basis.
• Holidays - A minimum of 10 paid holidays per year.
• Family Building Benefits - Includes adoption and fertility assistance.
• Paid Parental Leave - 11 weeks of paid leave for employees who meet eligibility criteria.
• Life Insurance & AD&D - 100% of premiums covered by Milliman.
• Short-Term and Long-Term Disability - Fully paid by Milliman.

Equal Opportunity

All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, national origin, disability, or status as a protected veteran.

#LI-REMOTE

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.