Pharmacy Benefit Auditor Specialist
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AI Summary
Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.
Brown & Brown is seeking a Pharmacy Benefit Audit Specialist to join our growing team.
This role supports clients by leveraging our proprietary software and PBM claims data to analyze claims data, identify findings, and develop / present findings to the clients to ensure PBMs are processing pharmacy claims in alignment with the clients’ contract. The Pharmacy Benefit Audit Specialist will develop and grow business relationships vital to the success of each audit project, which includes implementing, executing, and finalizing strict deadlines. They will also manage project development from beginning to end, which can include a variety of different types of PBM audits depending on the client audit requirements.
Our qualified professionals lead all aspects of the pharmacy benefit audit, helping our customers save money and minimize compliance risks. We provide best-in-class, value-based pharmacy solutions utilizing 100% review of your pharmacy claims. Our practical compliance guidance can help you maximize your financial outcomes, eliminate pharmaceutical waste & abuse, and increase member satisfaction.
How You Will Contribute:
Conducts Data Analysis for pharmacy benefits and contractual audits surrounding pharmacy claims. PBM audits can include, but are not limited to pricing, plan design, rebates, eligibility, CMS Data Validation, Fraud, Waste & Abuse, and performance guarantee review.
Includes gathering, implementing, executing, and finalizing audit rules and requirements from clients and PBMs into proprietary systems.
Assists with review of PBM contract(s) and contribute suggestions for improvement, based on knowledge of industry
Leverages the company’s reporting systems to conceptualize, design, and distribute both operational and analytical reports focused on pharmacy utilization and cost
Assists with developing, documenting, and evaluating the business requirements associated with data flows to and from the PBM and other vendors
Identifying issues and resolutions, and consulting management on potential solutions to facilitate critical decisions.
Generate audit reports and consult clients on the findings.
Works effectively on multiple client assignments or projects simultaneously
Plan, schedule, and track project timelines, milestones, and deliverables.
This position will include job duties that require risk designations for access to Electronic Protected Health Information (PHI) in the course of their job responsibilities
Skills & Experience to be Successful:
Required
Minimum of three years’ work experience in healthcare, health insurance fields pharmacy benefit management, with a focus on pharmacy claims processing and pharmacy benefits related activities
Ability to build and maintain strong, collaborative working relationships with multiple business units across the company
Strong communication skills (written and verbal)
Ability to maintain a high level of confidentiality
Proficient with MS Office Suite
Preferred
Associate degree or higher
Direct PBM claims auditing experience within a PBM and/or Health Plan
Pharmacy Technician Certification (CPhT) and/or pharmacy work experience
Pay Range
80,000.00 - 90,000.00 AnnualThe pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role.
Teammate Benefits & Total Well-Being
We go beyond standard benefits, focusing on the total well-being of our teammates, including:
- Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
- Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
- Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
- Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.
Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations.
Recruiting Vendor Disclosure Statement
Brown & Brown does not accept unsolicited resumes from external recruiters, recruitment vendors or employment agencies ("Recruiting Vendors"). Recruiting Vendors must have a valid written agreement and received prior written authorization from an authorized Brown & Brown representative before submitting candidates for any publicly posted role. Any unsolicited resumes submitted to Brown & Brown or its employees become the property of Brown & Brown, and no fees will be paid for such submissions. Additional information regarding this policy can be found on our careers page.
The Power To Be Yourself
As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.
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