Senior Consultant, Pharmacy Auditor

Discover a world of endless possibilities at Gallagher Benefit Services, where you'll have the power to shape the future of workplaces across industries. As a member of our team, you become the driving force behind positive change, helping clients build environments where employees thrive. Embrace the opportunity to impact lives, unlock potential, and create a legacy of remarkable transformation.

We believe that every candidate brings something special to the table, including you So, even if you feel that youre close but not an exact match, we encourage you to apply.

The Senior Consultant - Pharmacy Auditor is an integral part of the Pharmacy Audit Team and is responsible for performing and supporting Prescription Drug Claim Audits (claims, rebates, operational, Medicare, pre/post-implementation, etc.) to validate that the coverage of a prescription drug claim, and the payment of such claim, comply with the contractual, regulatory, and custom plan guidelines. Additionally, certain audits validate the proper reimbursement of prescription rebates from a Pharmacy Benefits Manager (PBM) to a client per the contractual arrangement. This position is client facing and requires an individual who can effectively manage client expectations as well as the ability to manage multiple projects without compromise of accuracy or timeliness.

• Project management of Prescription Drug Claim Audits from implementation through closure.
• Manage and perform audits of prescription drug claim payment data to validate conformance with contractual requirements and plan specifications as assigned.
• Review and evaluate Administrative Services Agreement between the employer and PBM.
• Work with dedicated data analytics team to define and translate plan provisions for testing purposes, ensuring that scope aligns with the statement of work and client commitments. Review client-specific documentation, Summary Plan Description(s), and other documentation such as copay grids, plan literals, set-up grids, etc., to develop the audit test filters.
• Complete the contract summary, or assist with completion of contract summaries, as assigned.
• Evaluate the results of the initial claim data tests and determine valid audit samples for review and response by the PBM.
• Prepare PBM communications regarding test results, response expectations, and clarifications to questions.
• Work collaboratively with PBM to resolve exceptions, review supporting documentation, and make final claim error determination.
• Ensure audit timeline is adhered to and deliver high level of service to clients.
• Perform Prescription Drug Claim Rebate audits as assigned. (Occasional travel to the PBM is required; 10-20% travel possible.)
• Prepare and present detailed audit reports which clearly articulate audit findings and recommendations to PBM and client.
• Maintain audit project work papers to support audit findings.
• Work collaboratively within the audit team, as well as with internal and external customers.
• Participate in team meetings, conference calls, Microsoft Teams meetings, etc. remotely with PBMs and audit team as necessary.
• Assist with claims data analysis and quality assurance as requested.
• Interact directly with clients and respond to client requests. Develop strong relationships with clients.
• Assist in supporting other auditors, Manager, Director, and Practice Leader as requested. Provide leadership and/or mentorship to less senior members of the audit team.
• Perform special projects or assignments, as instructed by Manager.
• Attain billable hours objective (apply acquired skills in client-productive ways).

Required:

• College degree (experience may be considered to waive the degree requirement)
• 10+ years experience in pharmacy auditing, consulting, or other applicable pharmacy industry experience
• Previous PBM experience is a plus but not required
• Must demonstrate a high level of pharmacy benefit, claim, or benefit administration knowledge - Medicare benefits experience is a strong plus
• Proficient in the use of Microsoft Office Suite of programs (Word, Excel, PowerPoint, Outlook, Teams)
• Excellent oral and written communication skills are required
• Excellent organizational and time management skills
• Personable communication style, positive outlook, leadership skills, and self-confidence
• Ability to multi-task and acclimate to changing priorities without losing focus
• Attention to detail and ability to clearly explain thought process in reaching documented conclusions
• Self-directed individuals who require little supervision and can manage multiple projects effectively to ensure deadlines are met
• Team player with a strong work ethic

On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.

Below are the minimum core benefits youll get, depending on your job level these benefits may improve:

• Medical/dental/vision plans, which start from day one
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave

Other benefits include:

• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...

We value inclusion and diversity

Click Here to review our U.S. Eligibility Requirements

Inclusion and diversity (I&D) is a core part of our business, and its embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as protected characteristics) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.