Senior Pharmacy Audit Lead - Hybrid, Client-Facing Expert

Mercer; Chicago (IL); Hybrid; USD 103,000 - 205,000; Full time

Benefits offered by this job

Health benefits

Tuition assistance

Retirement programs

Job summary

Mercer is seeking a Pharmacy Audit Lead Consultant to lead complex pharmacy claims and rebate audits from planning through final report. You will act as the primary consultant and pharmacist audit SME, partnering with internal teams to deliver defensible findings and drive growth.

The role is hybrid, requiring at least three days per week in the office, with opportunities to advise clients and mentor team members while embracing AI-enabled tools and innovative audit methods.

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.

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.
• Oversee claim and rebate review activity with consistent methodology and documentation.
• Quantify financial impact and drive issues to final resolution.
• Present methodology, findings, and recommendations to clients.

Skills

Pharmacy benefits

Claims auditing

Data analysis

Education

Bachelor's degree in pharmacy, healthcare, business, analytics, or related field

Advanced degree (PharmD, RPh, MBA, CPA)

Job description

Mercer is seeking a Pharmacy Audit Lead Consultant to lead complex pharmacy claims and rebate audits from planning through final report. You will act as the primary consultant and pharmacist audit SME, partnering with internal teams to deliver defensible findings and drive growth.

The role is hybrid, requiring at least three days per week in the office, with opportunities to advise clients and mentor team members while embracing AI-enabled tools and innovative audit methods.