Pharmacy Claims Audit Analyst

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.

Remedy Analytics is a consulting and analytics organization dedicated to supporting our clients with their pharmacy benefit program.  Remedy Analytics is an industry leader in delivering prescription drug benefit savings and analytics to our clients. You will join a talented team of specialized pharmacy benefit management industry professionals, clinicians, actuaries, engineers, auditors, and IT developers.

Remedy has a casual, friendly atmosphere and an entrepreneurial spirit. Remedy offers an outstanding opportunity to explore, understand and impact the future of healthcare. We are a true team in every sense, and we thrive on ideas, creating new possibilities and solving challenging problems.

We are looking for a full-time Pharmacy Claims Audit Analyst, with keen analytical skills and an eye for detail, to join our growing team. The Pharmacy Claims Audit Analyst will be responsible for completing pharmacy claims audits to ensure compliance to PBM contracts. This role will involve facilitating calls with PBMs, obtaining claims audit data, perform data quality checks, data reconciliation, running and analyzing Oracle output reports, running ad-hoc reporting, reviewing PBM contracts, completing audit support documentation and working with the client support team to develop PBM & client deliverables. This role will develop, prioritize, and conduct financial audits to evaluate the effectiveness of PBM contracts, controls, and accuracy of financial information. 

Job Responsibilities

• Plan and develop the audit approach for assigned projects consistent with guidelines established by Remedy internal Audit Standards
• Work simultaneously on multiple audits with differing deadlines while maintaining attention to detail within the appropriate timelines
• Track open audit observations and perform follow-up to evaluate the adequacy of remediation efforts with both PBM and Remedy account team
• Work with Lead auditor to continuously improve upon current audit automation transforms based on audit findings, industry changes, and technology updates
• Draft audit reports to effectively communicate the results of the analysis to Remedy account team
• Comply with and adhere to all regulatory compliance areas, policies, and procedures (including HIPAA requirements), and "leading practices"
• Perform (daily/weekly) ad hoc data reporting requests as prioritized per Department Management

Required Qualifications

• Bachelor’s degree in Business or Healthcare related field and/or similar discipline with analytical bias
• Pharmacy claims audit experience &/or knowledge of pharmacy claims data
• Experience working with Pharmacy and/or Medical claims data
• Relevant experience that demonstrates problem-solving, financial acumen, and analytical output
• Proficiency in MS Office applications (Excel, Word, Powerpoint, etc.)
• Ability to thrive in a fast-paced environment, responding quickly to oversight and following instruction closely, while anticipating needs and developing efficiencies on repeat tasks
• Excellent verbal and written communication skills to assemble data as applicable
• Experience developing and maintaining effective, collaborative working relationships with clients and internal stakeholders
• Strong sense of project ownership and the ability to manage high project volume effectively
• Excellent problem-solving, critical thinking and analytics skills with the ability to work in a cross-functional team
• Must be able to adapt to change in direction and priorities in a project and deadline-oriented environment.

Preferred but not required

• Experience in Project Management
• Familiarity with low code to no code solutions
• Experience working with data and reporting

Pay Range

The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role.

Teammate Benefits & Total Well-Being

We go beyond standard benefits, focusing on the total well-being of our teammates, including:

• 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. 

Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. 

The Power To Be Yourself  

As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.