Pharmacy Claims & Rebates Audit Lead (Hybrid)

Marsh; Atlanta (GA); Hybrid; USD 103,000 - 205,000; Full time

Benefits offered by this job

Health benefits

Tuition assistance

401K retirement plan

Employee assistance programs

Job summary

Mercer’s Health & Benefits team is seeking a Pharmacy Claims and Rebates Audit Consultant to lead complex audits from planning through final report, applying deep expertise in pharmacy benefits and rebate economics. This is a hybrid role based near any US office with in-office three days per week.

You will act as the primary audit SME for clients, translate contracts into audit scope, oversee reviews, quantify financial impact, present findings, and mentor team members while innovating with

Qualifications

• Bachelor's degree in pharmacy, healthcare, business, finance, analytics, or related field.
• 8+ years of experience in pharmacy claims auditing, PBM operations, or health plan administration.
• Strong 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.
• Translate PBM contracts, pricing guarantees, formulary terms, and rebate agreements into audit scope and defensible sample selection.
• Oversee claim and rebate review activity, ensuring consistent methodology and clear documentation.
• Quantify financial impact, evaluate vendor responses, and drive issues to final resolution.
• Serve as primary client contact, presenting methodology, findings, and recommendations.
• Mentor team members and drive quality checkpoints for audit work.
• Thrive and be motivated by AI and technology-enabled tools.

Skills

Pharmacy auditing

PBM operations

Consulting experience

Leadership

Mentoring

Analytics-driven audits

AI/tech-enabled tools

Client engagement

Education

Bachelor's degree in pharmacy/healthcare/analytics

Advanced degree (PharmD/RPh/MBA/CPA)

Tools

Analytics SaaS tools

Job description

Mercer’s Health & Benefits team is seeking a Pharmacy Claims and Rebates Audit Consultant to lead complex audits from planning through final report, applying deep expertise in pharmacy benefits and rebate economics. This is a hybrid role based near any US office with in-office three days per week.

You will act as the primary audit SME for clients, translate contracts into audit scope, oversee reviews, quantify financial impact, present findings, and mentor team members while innovating with