Pharmacy Benefit Audit Specialist

4 weeks ago


Miami, Florida, United States Secure Eclaims LLC Full time
Job Summary

We are seeking a highly skilled Pharmacy Benefit Audit Specialist to join our team at Secure Eclaims LLC. As a key member of our team, you will be responsible for reviewing and understanding PBM contracts, plan design documents, and proprietary Compliance Model to ensure accurate calculations and reporting.

Key Responsibilities:

  • Review and understand PBM contracts for all relevant pricing terms
  • Review and understand plan design documents provided by PBM or client
  • Utilize company's proprietary Compliance Model to calculate client contractual financial guarantees, admin fees, rebates, and other terms
  • Assemble audit reports and summarize findings
  • Document all potential issues and track decisions
  • Collaborate with account management and pharmacy consultants to discuss results with clients and vendors
  • Provide documentation during follow-up negotiations and discussions
  • Work with IT to further develop Compliance Model logic and capabilities
  • Assist in other financial projects as needed

Requirements:

  • Bachelor's degree in Business, Finance, or other health-related field
  • At least 3 years of experience in pharmacy benefit audit or claim adjudication research on one or more PBM platforms
  • Working knowledge of the PBM industry and pharmacy benefit claims

Desired Skills:

  • Proficient in Microsoft Office, with extensive experience working with Excel
  • Basic SQL query building
  • Strong verbal and written communication skills
  • Detail-oriented
  • Solid, independent worker
  • Pharmacy Technician Certification (preferred)

About Secure Eclaims LLC:

Secure Eclaims LLC is a leading specialty benefits management company in Puerto Rico and South Florida. Our innovative care management model integrates the needs of providers, payors, and members to ensure the delivery of high-quality, cost-effective care while realizing substantial millions of dollars in savings.

We are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology. Through our experience in the healthcare industry, we aim to improve healthcare outcomes, achieve cost savings, and serve as a single point of contact to move into value-based care.



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