Pharmacy Benefit Auditor Specialist at 001 Brown & Brown, Inc — Remote

Brown & Brown is seeking a Pharmacy Benefit Audit Specialist to join our growing team.

This role supports clients by leveraging our proprietary software and PBM claims data to analyze claims data, identify findings, and develop / present findings to the clients to ensure PBMs are processing pharmacy claims in alignment with the clients’ contract. The Pharmacy Benefit Audit Specialist will develop and grow business relationships vital to the success of each audit project, which includes implementing, executing, and finalizing strict deadlines. They will also manage project development from beginning to end, which can include a variety of different types of PBM audits depending on the client audit requirements.

Our qualified professionals lead all aspects of the pharmacy benefit audit, helping our customers save money and minimize compliance risks. We provide best-in-class, value-based pharmacy solutions utilizing 100% review of your pharmacy claims. Our practical compliance guidance can help you maximize your financial outcomes, eliminate pharmaceutical waste & abuse, and increase member satisfaction.

How You Will Contribute:

• 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.
• This position will include job duties that require risk designations for access to Electronic Protected Health Information (PHI) in the course of their job responsibilities

Skills & Experience to be Successful:

Required

• 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

Pay Range

80,000.00 - 90,000.00 Annual

Teammate Benefits & Total Well-Being

• 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.

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