Senior Pharmacy Claims & Rebates Audit Lead

Mercer; Phoenix (AZ); Hybrid; USD 103,000 - 205,000; Full time

Benefits offered by this job

Health benefits

Tuition assistance

401(k) savings

Employee assistance programs

Hybrid work arrangement

Job summary

Mercer Health & Benefits is seeking a Pharmacy Audit Lead Consultant to drive complex audits from planning to final report, applying deep expertise in pharmacy benefits and rebate economics. This hybrid role can be based near any US office, requiring three days in the office weekly.

You will act as the primary consultant, translate contracts into audit scope, quantify financial impact, and lead a skilled audit team while pursuing innovation in audit practices.

Qualifications

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

Responsibilities

• Lead end-to-end pharmacy claims and rebate audits for high-visibility clients.
• Translate PBM contracts, pricing guarantees, formulary terms, and rebates into audit scope.
• Oversee claim and rebate review activity with consistent methodology.
• Quantify financial impact, evaluate vendor responses, and drive to final resolution.
• Serve as primary client contact, presenting methodology and findings.
• Partner with internal consultants as the pharmacy audit subject-matter expert.
• Identify opportunities to expand services and support new business development.
• Mentor team members and embrace AI and technology-enabled tools.

Skills

Pharmacy claims auditing

PBM operations

Pharmacy benefit consulting

Health plan administration

Client-facing

Education

Bachelor's degree

Advanced degree (PharmD/MBA/etc)

Job description

Mercer Health & Benefits is seeking a Pharmacy Audit Lead Consultant to drive complex audits from planning to final report, applying deep expertise in pharmacy benefits and rebate economics. This hybrid role can be based near any US office, requiring three days in the office weekly.

You will act as the primary consultant, translate contracts into audit scope, quantify financial impact, and lead a skilled audit team while pursuing innovation in audit practices.