Pharmacy Auditor

Pharmacy Auditor at Gallagher

Join us as a Pharmacy Auditor at Gallagher.

$80,000.00/yr - $/yr

At Gallagher Benefit Services, we help clients build better workplaces where people feel supported, empowered, and inspired to thrive. We help clients shape benefit strategies, design wellbeing programs, and advise on workforce challenges. Our culture encourages curiosity, collaboration, and growth. If you’re looking for a place where your contribution matters and helps build a better world of work, Gallagher is the place.

• Project manage Prescription Drug Claim Audits from implementation through closure.
• Manage and perform audits of prescription drug claim payment data to validate conformance with contractual requirements and plan specifications as assigned.
• Review and evaluate Administrative Services Agreements between the employer and PBM.
• Work with data analytics to define and translate plan provisions for testing, ensuring scope aligns with the statement of work and client commitments. Review client‑specific documentation, Summary Plan Descriptions, copay grids, plan literals, set‑up grids, etc., to develop audit test filters.
• Complete or assist with contract summaries as assigned.
• Evaluate the results of initial claim data tests and determine valid audit samples for review and response by the PBM.
• Prepare PBM communications regarding test results, response expectations, and clarifications to questions.
• Collaborate with PBM to resolve exceptions, review supporting documentation, and make final claim error determinations.
• Adhere to audit timeline and deliver high‑level client service.
• Perform Prescription Drug Claim Rebate audits as assigned (occasional travel to PBM required; 10‑20% travel possible).
• Prepare and present detailed audit reports that clearly articulate findings and recommendations to PBM and client.
• Maintain audit project work papers to support audit findings.
• Collaborate within the audit team and with internal and external customers.
• Participate in team meetings, conference calls, Microsoft Teams meetings, and PBM remote calls as necessary.
• Assist with claims data analysis and quality assurance as requested.
• Interact directly with clients and respond to client requests; develop strong client relationships.
• Provide leadership and/or mentorship to less senior auditors; support assignments of Manager, Director, and Practice Leader.
• Perform special projects or assignments as instructed by Manager.
• Attain billable hours objective (apply acquired skills in client‑productive ways).

• College degree (experience may be considered to waive the degree requirement)
• 10+ years’ experience in pharmacy auditing, consulting, or other applicable pharmacy industry experience
• Previous PBM experience is a plus but not required
• High level of pharmacy benefit, claim, or benefit administration knowledge;
  Medicare benefits experience is a strong plus
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Teams)
• Excellent oral and written communication skills
• Excellent organizational and time‑management skills
• Personable communication style, positive outlook, leadership skills, and self‑confidence
• Ability to multi‑task and adapt to changing priorities without losing focus
• Attention to detail and ability to clearly explain thought process in reaching documented conclusions
• Self‑directed and capable of managing multiple projects with minimal supervision to meet deadlines
• Team player with a strong work ethic

We offer a competitive and comprehensive compensation package. The base salary range represents the low and high ends of the anticipated range for this position. Actual compensation will be influenced by factors including experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, you will receive a wide range of benefits.

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax‑advantaged accounts (HSA, FSA)
• Educational expense…