Pharmacy Audit Lead: PBM & Data Insights

Gallagher; Richmond (VA); On-site; Confidential; Full time

Benefits offered by this job

Competitive compensation

Comprehensive benefits

Career development opportunities

Collaborative culture

Job summary

Gallagher Benefit Services seeks a Pharmacy Auditor to join its Pharmacy Audit Team. You will lead Prescription Drug Claim audits, validate data against contracts and plan specs, and coordinate with PBMs and clients to ensure accuracy and timeliness.

Role requires 5+ years of experience, PBM process knowledge, and strong data analytics skills using Excel, SQL, Tableau, and Power BI. Occasional travel may be required.

Qualifications

• Typically requires a University Degree or equivalent experience and minimum 5 years of prior relevant experience.
• Proven experience in managing client relationships and delivering high-quality client services.
• Strong background in pharmacy benefit management (PBM) processes and systems.
• Extensive experience with data analysis tools (e.g., Excel, SQL, Tableau, Power BI).

Responsibilities

• Project management of Prescription Drug Claim Audits from implementation through closure.
• Manage and perform audits of prescription drug claim payment data to validate conformance with contractual requirements and plan specifications as assigned.
• Review and evaluate Administrative Services Agreement between the employer and PBM.
• Work with dedicated data analytics team to define and translate plan provisions for testing purposes, ensuring that scope aligns with the statement of work and client commitments.
• Complete the contract summary, or assist with completion of contract summaries, as assigned.
• Evaluate the results of the initial claim data tests and determine valid audit samples for review and response by the PBM.
• Prepare PBM communications regarding test results, response expectations, and clarifications to questions.
• Work collaboratively with PBM to resolve exceptions, review supporting documentation, and make final claim error determination.
• Ensure audit timeline is adhered to and deliver a high level of service to clients.
• Perform Manufacturer Rebate audits as assigned. (Occasional travel to the PBM is required; 10-20% travel possible.)
• Prepare and present detailed audit reports which clearly articulate audit findings and recommendations to PBM and client.
• Maintain audit project work papers to support audit findings.
• Work collaboratively within the audit team, as well as with internal and external customers.
• Participate in team meetings, conference calls, Microsoft Teams meetings, etc. remotely with PBMs, clients, and audit team as necessary.
• Assist with claims data analysis and quality assurance as requested.
• Interact directly with clients and respond to client requests. Develop strong relationships with clients.
• Assist in supporting other auditors, Directors, and Practice Leader as requested.
• Perform special projects or assignments, as instructed by Director.

Skills

Client relations

PBM processes

Data analytics

Excel

SQL

Tableau

Power BI

Education

University degree

Healthcare Administration

Data Analytics

Job description

Gallagher Benefit Services seeks a Pharmacy Auditor to join its Pharmacy Audit Team. You will lead Prescription Drug Claim audits, validate data against contracts and plan specs, and coordinate with PBMs and clients to ensure accuracy and timeliness.

Role requires 5+ years of experience, PBM process knowledge, and strong data analytics skills using Excel, SQL, Tableau, and Power BI. Occasional travel may be required.