Pharmacy Benefit Auditor – Specialist

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Brown & Brown Insurance

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1939

💸 Finance

Finance • Insurance

Brown & Brown Insurance is one of the largest independent insurance brokerages globally, providing a comprehensive range of risk management solutions. Established in 1939, the company offers personal and business insurance, employee benefits, and various national programs. Brown & Brown is committed to diversity, inclusion, and belonging, fostering a culture that values talent and experience. With over 500 locations, the company is well-positioned to meet the diverse needs of its clientele and is listed on the New York Stock Exchange under the ticker BRO. The firm's strategic focus on mergers and acquisitions highlights its disciplined growth strategy.

📋 Description

• Conducts Data Analysis for pharmacy benefits 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 clients on the findings. • Works effectively on multiple client assignments or projects simultaneously • Plan, schedule, and track project timelines, milestones, and deliverables.

🎯 Requirements

• Minimum of three 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 • Preferred Associate degree or higher • Direct PBM claims auditing experience within a PBM and/or Health Plan • Pharmacy Technician Certification ( CPhT ) and/or pharmacy work experience

🏖️ Benefits

• Health Benefits : Medical/Rx • Dental • Vision • Life Insurance • Disability Insurance • Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement • Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services • Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more.