Auditor, PBM Contracts

Come join our team!

For over 30 years PSG has been singularly focused on helping our clients navigate the complex and ever-changing challenges of drug management. Through our leading pharmacy intelligence and technologies, we save our clients billions of dollars every year with an unwavering commitment to serving as your advocate and strategic partner. PSG has market leading technology and administration services for hospitals and health systems.

Our mission is to relentlessly advocate for our clients as we partner together to develop innovative drug management solutions that deliver exceptional strategic insights, financial and clinical value.

JOB OVERVIEW:

As a Pharmacy Benefit Audit Analyst, you will be responsible for conducting audits on behalf of our clients. This includes review of PBM contracts and related guarantees (financal, performance, benefit, network, clinical, etc) for clients from all PSG client market segments:  Employer, Labor, Hospital and Health Plan (including those programs dictated by participation in government programs, e.g. Medicaid and Medicare D).  It requires the review of prescription claims for pricing and plan design accuracy per the plan documentation provided as well as regulatory requirements. It also includes analysis of administrative fees and applicable drug rebates paid against the contracts. A high attention to detail and process will be critical for success.

Scope of work:

• Subject matter expert with deep understanding and knowledge of PBM contracts and terms
• Review and interpret plan design documents and contractual obligations
• Calculate client contractual financial guarantees, admin fees, rebates and other terms as required by client contract
• Ensure compliance with benefit validation requirements (including but not limited to plan design, clinical criteria, etc.)
• Assemble audit reports and summarize findings
• Document all potential issues and track decisions
• Collaborate with account management and pharmacy consultants to discuss and present results with clients and vendors
• Provide documentation during follow-up negotiations and discussions
• Document project statuses including all potential issues and track decisions including escalations
• Assist in other data or financial projects as needed

LOCATION: Remote

Qualifications: 

• Bachelor’s degree in Business, Finance, or other health related field
• At least 5 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
• Proficient in Microsoft Office, with extensive experience working with Excel

• Strong analytical, problem-solving, organization, critical thinking, and time management skills
• Excellent attention to detail and quality
• Proficient in SQL to extract data and build queries

• Strong written and verbal communication skills and discipline to multitask and prioritize projects to meet scheduled deadlines.
• Previous Medicare Part D experience preferred

• Ability to interact with diverse group of stakeholders including executives, managers, clients, and subject matter experts both technical and non-technical.
• Ability for some travel (5% - 10%)

COMPENSATION: 

The national average salary for this role is $100 000.00 - $130 000.00 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on your experience, skills, training, certifications and education, while also considering internal equity and market data.

To learn more about EPIC, visit our Careers Page: https://www.epicbrokers.com/about/epic-careers/. 

EPIC embraces diversity in all its various forms—whether it be diversity of thought, background, race, religion, gender, skills or experience. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard. It is our belief that diversity drives innovation and that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients. 

California Applicants - View your privacy rights at: https://www.epicbrokers.com/wp-content/uploads/2025/01/epic-ca-employee-privacy-notice.pdf. 

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