Senior Pharmacy Audit Coordinator

The Health & Benefits (H&B) Claims Auditor will a lead consultant managing health claims and operations audit projects and present reports on behalf of our clients to ensure the claims administrators are in compliance with the clients contracted benefit plan. To fulfill the role, the H&B Claims Auditor will:

  • Manage a project from start to finish of a client project to evaluate the accuracy and effectiveness of a Pharmacy Benefit Manager's (PBM's) performance administering the client's various pharmacy benefit plans. The project should be completed on-time, within budget, and with high quality
  • Understand the plan materials available from each PBM
  • Analyze plan materials and contracts to ensure everything is available for the audit
  • Communication with the PBM as well as the client throughout the process
  • Understanding of industry terminology and strong experience with analyzing pharmacy claims data
  • Program plan design and contract parameters using an Excel based application
  • Review of audit exceptions and import into an Excel based application for distribution to the PBM
  • Analysis of PBM's response, including confirmation it is consistent with claim/plan parameters; documentation provided adequately supports response; follow-up where necessary
  • Consolidating overall findings and recommendations in an audit report
  • Throughout each project, ensure that work is reviewed and offer assistance reviewing others work


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