Pharmacy Audit Data Analyst

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $59.2k - $109k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📉 Data Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Milliman

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1947

🏥 Healthcare

🛡️ Insurance

💼 Consulting

Healthcare • Insurance • Consulting

Milliman is an independent global actuarial and consulting firm founded in 1947 that provides expertise in insurance, healthcare, retirement and employee benefits, risk management, and related financial services. The firm combines actuarial rigor, data science, and technology to deliver consulting, modeling, software, and advisory solutions to public- and private-sector clients addressing challenges such as healthcare costs, market volatility, climate risk, and program design. Milliman operates worldwide with multidisciplinary teams including actuaries, data scientists, clinicians, and software engineers.

📋 Description

• Perform audit testing of pharmacy claims data against contract terms, including pricing guarantees, administrative fees, and other contractual financial guarantees • Write, troubleshoot, and optimize SQL queries in SQL Server Management Studio to analyze large pharmacy claims data sets • Conduct rebate audits, including minimum rebate guarantee reconciliations, pass-through rebate testing, and rebate credit reviews • Translate client and PBM contracts into audit rules by identifying guarantee terms, exclusions, and reporting requirements • Build and maintain validation checks for data completeness and accuracy • Design, document, and implement new audit tests as contract terms, regulations, and industry standards evolve • Prepare client-ready exhibits and reports communicating audit findings and financial impact • Research PBM responses and rebuttals and substantiate findings with claim-level detail • Identify and communicate data limitations and unvalidated findings • Communicate findings and data-driven recommendations to clients, PBMs, and internal consultants • Respond to ad hoc data requests, claims data monitoring, data pulls, analyses, and exhibits • Contribute to process improvements, automation, and internal audit tools and templates

🎯 Requirements

• Bachelor's degree, preferably in math, health, science, or business discipline • 2–6 years of relevant experience • Experience in health insurance, pharmacy benefit design, or the PBM industry • Working knowledge of pharmacy benefit concepts, including copays/coinsurance, AWP-based pricing, MAC, brand and generic classification, specialty drugs, formulary design, and rebates • Ability to write and troubleshoot SQL queries; SQL Server Management Studio experience preferred • Proficiency in Excel, Word, and PowerPoint, including work with large data sets • Strong analytical, problem-solving, and documentation skills • Ability to work independently and prioritize competing demands across multiple engagements • Ability to explain technical terms, data, and analytic concepts clearly to non-technical audiences • Exceptional attention to detail and accuracy • Intellectual curiosity and willingness to question results • Effective written and verbal communication skills • Ownership, accountability, and critical thinking • Legally authorized to work in the United States without immigration support or sponsorship now or in the future

🏖️ Benefits

• Medical, Dental and Vision coverage for employees, dependents, and domestic partners • Employee Assistance Program (EAP) • 401(k) plan with company matching and profit-sharing contributions • Discretionary Bonus Program • Flexible Spending Accounts (FSA) • Paid Time Off (PTO); full-time employees accrue 15 days per year • Minimum of 10 paid holidays per year • Family Building Benefits, including adoption and fertility assistance • 11 weeks of paid parental leave for eligible employees • Life Insurance & AD&D; 100% of premiums covered by Milliman • Short-Term and Long-Term Disability; fully paid by Milliman • Skills training and career development • Learning and mentoring opportunities • Employee Resource Groups (ERGs)