Senior Client Audit Engineer - Pharmacy

Proforma Health Inc; Madison (WI); On-site; USD 90,000 - 140,000; Full time

Benefits offered by this job

Health insurance

Mental health support

Work-life balance

Job summary

Proforma Health Inc. is seeking a Senior Client Audit Engineer - Pharmacy to lead and execute pharmacy claims audits, ensuring adherence to PBM contracts and regulatory requirements.

You will design audit plans, manage multiple concurrent audits, and collaborate with engineering to build data solutions using Python and SQL. The role emphasizes HIPAA compliance, stakeholder communication, and driving process improvements through data-driven insights.

Qualifications

• Bachelor’s degree in computer science, engineering, or related field.
• Proficiency in database management, ETL processes, SQL, and Oracle.
• Experience with data modeling, business logic, and problem-solving.
• Strong communication skills and ability to build stakeholder relationships.
• Ability to handle high project volumes and adapt to changing priorities.
• Preferred experience with pharmacy claims data, project management, version control, and visualization tools.

Responsibilities

• Develop and execute audit plans aligned with internal standards.
• Manage multiple audits simultaneously, maintaining accuracy and deadlines.
• Analyze data, perform quality checks, and ensure proper system and master file updates.
• Improve audit automation processes based on findings and industry trends.
• Track audit observations, follow up on remediation efforts, and draft detailed reports.
• Perform ad hoc data analyses and identify operational efficiencies.
• Collaborate with engineering and product teams to prototype data solutions using Python and SQL.
• Train junior staff and ensure compliance with regulatory policies, including HIPAA.

Skills

Data analysis

Stakeholder management

Problem solving

Adaptability

Communication

Education

Bachelor’s degree in computer science, engineering, or related field

Tools

SQL

Oracle

ETL

Python

Data modeling

Version control

Visualization tools

Job description

Role Overview: The Senior Client Audit Engineer - Pharmacy is responsible for conducting pharmacy claims audits to ensure compliance with PBM contracts.

Key Responsibilities

• Develop and execute audit plans aligned with internal standards.
• Manage multiple audits simultaneously, maintaining accuracy and deadlines.
• Analyze data, perform quality checks, and ensure proper system and master file updates.
• Improve audit automation processes based on findings and industry trends.
• Track audit observations, follow up on remediation efforts, and draft detailed reports.
• Perform ad hoc data analyses and identify operational efficiencies.
• Collaborate with engineering and product teams to prototype data solutions using Python and SQL.
• Train junior staff and ensure compliance with regulatory policies, including HIPAA.

Qualifications & Skills

• Bachelor’s degree in computer science, engineering, or related field.
• Proficiency in database management, ETL processes, SQL, and Oracle.
• Experience with data modeling, business logic, and problem-solving.
• Strong communication skills and ability to build stakeholder relationships.
• Ability to handle high project volumes and adapt to changing priorities.
• Preferred experience with pharmacy claims data, project management, version control, and visualization tools.

Additional Information

The role offers a competitive salary range and benefits focused on health, financial wellness, mental health, and work-life balance, emphasizing an inclusive, diverse environment.