Pharmacy Benefit Audit Expert

4 days ago


Miami, Florida, United States Secure Eclaims LLC Full time

About Secure Eclaims LLC

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

Job Description:

We are seeking a Pharmacy Benefit Audit Expert to join our team. As a Pharmacy Benefit Audit Expert, you will review and understand PBM contracts for all relevant pricing terms, review and understand plan design documents provided by PBM or client, utilize our proprietary Compliance Model, calculate client contractual financial guarantees, admin fees, rebates, and other terms as required by client contract, assemble audit reports, summarize findings, document all potential issues, 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, and assist in other financial projects as needed.

Required Skills and Qualifications:

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

Estimated Salary: $65,000 - $85,000 per year, depending on experience and qualifications.



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