Pharmacy Audit Data Analyst

Milliman

. Perform audit testing of pharmacy claims data against contract terms, including pricing guarantees, administrative fees, and other contractual financial guarantees .

Posted 10/2/2026full-timeRemote • United StatesJuniorMid-Level💰 $59,200 - $109,020 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing pharmacy claims data, including contract compliance and rebate analysis, while effectively communicating findings to clients and stakeholders. Proficient in SQL query writing and data analysis, with a strong focus on accuracy and process improvement.

Highest-signal resume keywords

SQL Query WritingPharmacy Benefit ConceptsData AnalysisAudit TestingEffective Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

SQLData AnalysisAudit TestingRebate AuditsData ValidationContract AnalysisExcelWordPowerPointDocumentation

Soft Skills

Analytical SkillsProblem-SolvingAttention to DetailCritical ThinkingCommunication Skills

Tools & Technologies

SQL Server Management StudioExcelWordPowerPoint

Industry Keywords

Pharmacy Benefit ManagerHealth InsuranceRebatesFormulary DesignAWP-Based PricingCopaysCoinsuranceSpecialty DrugsMACContract Terms

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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)