Remote Pharmacy Audit Data Analyst - Claims & Rebates

Ultipro; San Diego (CA); Hybrid; USD 68,000 - 109,000; Full time

Benefits offered by this job

Medical, Dental and Vision

401(k) Plan

Discretionary Bonus Program

Paid Time Off

Holidays

Life Insurance

Job summary

Milliman is seeking a Pharmacy Audit Data Analyst for its San Diego Health practice to perform data analysis on pharmacy claims, rebates, and guarantees. You will translate contracts into audit rules and develop testable audit logic, working hands‑on in SQL with large datasets and building data quality checks.

Remote work option may apply. You will prepare client-ready exhibits and reports, communicate findings to clients and PBMs, and contribute to process improvements and internal audit tools.

Qualifications

• Bachelor's degree in math, health, science, or business preferred.
• 2-6 years of relevant experience in health insurance, PBM, or related fields.
• Working knowledge of PBM concepts including copays, AWP-based pricing, MAC, formulary design, and rebates.
• Ability to write and troubleshoot SQL queries; experience with SSMS preferred.
• Proficiency in Excel, Word, and PowerPoint with large data sets.
• Strong analytical, problem-solving, and documentation skills.
• Ability to work independently and manage competing demands across engagements.

Responsibilities

• Perform audit testing of pharmacy claims data against contract terms, including discount and dispensing fee pricing 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 rebate credit reviews.
• Translate client and PBM contracts into audit rules identifying guarantee terms and reporting requirements.
• Build and maintain validation checks for data completeness and accuracy before analysis.
• Design, document, and implement new audit tests as terms evolve.
• Prepare client-ready exhibits and reports communicating audit findings and financial impact.
• Support resolution by researching PBM responses and substantiating findings with claim-level detail.

Skills

SQL

Excel

PowerPoint

Data analysis

Documentation

Communication

Independent work

Education

Bachelor's degree in math/health/science/business

Tools

SQL Server Management Studio

Job description

Milliman is seeking a Pharmacy Audit Data Analyst for its San Diego Health practice to perform data analysis on pharmacy claims, rebates, and guarantees. You will translate contracts into audit rules and develop testable audit logic, working hands‑on in SQL with large datasets and building data quality checks.

Remote work option may apply. You will prepare client-ready exhibits and reports, communicate findings to clients and PBMs, and contribute to process improvements and internal audit tools.