Pharmacy Audit Lead — AI-Driven Claims & Rebates

Mercer; Houston (TX); Hybrid; USD 103,000 - 205,000; Full time

Job summary

Mercer seeks a Pharmacy Audit Lead Consultant to head complex audits of pharmacy claims and rebates, applying deep knowledge of PBM contracts and rebate economics. You will serve as the primary audit SME and client liaison, partnering with internal teams to deliver defensible findings and drive practice growth.

The role requires a Bachelor's in a related field and 8+ years in pharmacy audits, with strong data mastery and communication skills. Hybrid work with three days in office is expected.

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 pharmacy rebate structures.
• Client-facing experience in a consulting environment.

Responsibilities

• Lead end-to-end pharmacy claims and rebate audits for complex, high-visibility clients with deep knowledge of claim fields and data elements.
• Translate PBM contracts, pricing guarantees, formulary terms, and rebates into audit scope and sample selection using analytics tools.
• Oversee claim and rebate review activity with consistent methodology 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.
• Partner with internal consultants as the pharmacy audit SME.
• Identify opportunities to expand services and support new business development and drive audit innovation.
• Mentor team members and act as a quality checkpoint for audit work.
• Thrive in an environment that embraces AI and technology-enabled tools.

Skills

Pharmacy claims auditing

PBM operations

Pharmacy benefit consulting

Health plan administration

Client-facing

Education

Bachelor's degree in pharmacy or related field

Advanced degree (PharmD/RPh/MBA/CPA)

Tools

SaaS analytics tools

Job description

Mercer seeks a Pharmacy Audit Lead Consultant to head complex audits of pharmacy claims and rebates, applying deep knowledge of PBM contracts and rebate economics. You will serve as the primary audit SME and client liaison, partnering with internal teams to deliver defensible findings and drive practice growth.

The role requires a Bachelor's in a related field and 8+ years in pharmacy audits, with strong data mastery and communication skills. Hybrid work with three days in office is expected.