Pharmacy Benefit Auditor

Brown & Brown Insurance

1d•$90,000 - $105,000

About The Position

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 Auditor 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 Senior Pharmacy Benefit Audit Specialist will develop and grow business relationships vital to the success of each audit project, which includes implementing, executing, and finalizing with 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. They will additionally begin to mentor team members and begin testing new resource enhancements. How You Will Contribute: Conducts Data Analysis for pharmacy benefit 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 with client 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 Other duties may be assigned.

Requirements

Pharmacy Technician Certification (CPhT) and/or pharmacy work experience
Minimum of 3 to 5 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

Nice To Haves

Associate degree or higher (preferred)
Direct PBM claims auditing experience within a PBM and/or Health Plan (preferred)

Responsibilities

Conducts Data Analysis for pharmacy benefit 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 with client 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
Other duties may be assigned.