Senior Pharmacy Audit Lead — Hybrid, Client-Facing

Mercer; Los Angeles (CA); Hybrid; USD 103,000 - 205,000; Full time

Job summary

Mercer is seeking a Pharmacy Audit Lead Consultant to join its Health & Benefits team. The role can be based near any US office and is hybrid, requiring at least three days in the office weekly.

You will lead end-to-end pharmacy claims and rebate audits, translate contracts into audit scope, oversee review activity, quantify financial impact, and present findings to clients. Mentoring and business development are also part of the role.

Qualifications

• Bachelor's degree in pharmacy, healthcare, business, analytics, or related field.
• Minimum of 8 years of experience in pharmacy claims auditing, PBM operations, pharmacy benefit consulting, or health plan administration.
• Excellent knowledge of pharmacy benefits, claims adjudication, formulary administration, and specialty pharmacy.
• Strong knowledge of PBM contract terms, pricing methodologies, and pharmacy rebate structures.
• Client-facing experience in a consulting environment, with the ability to partner effectively with internal consultants.

Responsibilities

• Lead end-to-end pharmacy claims and rebate audits for complex, high-visibility clients, applying deep working knowledge of pharmacy claims data and every claim field and component to identify mispriced or misadjudicated claims.
• Translate PBM contracts, pricing guarantees, formulary terms, and rebate agreements into audit scope and defensible sample selection using analytics/SaaS tools.
• Oversee claim and rebate review activity, ensuring consistent methodology, sound judgment, and clear documentation across the team.
• Quantify financial impact, evaluate vendor responses, and drive issues to final resolution.
• Serve as primary client contact, presenting methodology, findings, and recommendations with clarity and confidence.
• Partner with internal consultants as the pharmacy audit subject‑matter expert.
• Identify opportunities to expand services and support new business development, while driving innovation in audit methodology and tools.
• Mentor team members and serve as a key quality checkpoint for audit work.

Skills

Pharmacy claims auditing

PBM contracts

Analytics

Client-facing

Leadership

Audit methodology

Education

Bachelor's degree in pharmacy

Tools

Analytics/SaaS tools

Job description

Mercer is seeking a Pharmacy Audit Lead Consultant to join its Health & Benefits team. The role can be based near any US office and is hybrid, requiring at least three days in the office weekly.

You will lead end-to-end pharmacy claims and rebate audits, translate contracts into audit scope, oversee review activity, quantify financial impact, and present findings to clients. Mentoring and business development are also part of the role.