Remote Pharmacy Audit Data Analyst - Claims & Rebates

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

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.