Pharmacy Claims and Rebates Audit Consultant

Company:

Mercer

Description:

We are seeking a talented individual to join our Health & Benefits team part of our People and Investments business at Marsh. This role can be based near any of our US offices. This is a hybrid role that has a requirement of working at least three days a week in the office.

As a Pharmacy Claims and Rebates Audit Consultant you will lead complex pharmacy claims and pharmacy rebate audits from planning through final report applying deep expertise in pharmacy benefits PBM contracts and rebate economics. You will act as the primary consultant and pharmacy audit subject-matter expert for our clients partnering closely with internal consultants to deliver clear defensible findings while driving growth and innovation across the practice.

We will count on you to:

• Lead end-to-end pharmacy claims and rebate audits for complex high-visibility clients applying deep working knowledge of pharmacy claims data and every claim field and component (e.g. NDC days supply quantity ingredient cost dispensing fee copay/coinsurance DAW code prior authorization and plan/formulary edits) to manually and analytically identify claims that were mispriced misadjudicated or paid outside of contract or plan terms.
• Translate PBM contracts pricing guarantees formulary terms and rebate agreements into audit scope and defensible sample selection using analytics/SaaS tools.
• Oversee claim and rebate review activity ensuring consistent methodology sound judgment and clear documentation across the team.
• Quantify financial impact evaluate vendor responses and drive issues to final resolution.
• Serve as primary client contact presenting methodology findings and recommendations with clarity and confidence.
• Partner with internal consultants as the pharmacy audit subject-matter expert.
• Identify opportunities to expand services and support new business development while driving innovation in audit methodology tools and practice capabilities.
• Mentor team members and serve as a key quality checkpoint for audit work.
• Thrive and be motivated by an environment that embraces AI and technology-enabled tools.

What you need to have:

• Bachelors degree in pharmacy healthcare business finance analytics or related field.
• Minimum of 8 years of experience in pharmacy claims auditing PBM operations pharmacy benefit consulting or health plan administration.
• Excellent knowledge of pharmacy benefits claims adjudication formulary administration and specialty pharmacy including strong command of pharmacy claim fields and data elements and what they indicate about how a claim was processed and paid.
• Strong knowledge of PBM contract terms pricing methodologies and pharmacy rebate structures (guarantees pass-through reporting).
• Client-facing experience in a consulting environment with the ability to partner effectively with internal consultants.

What makes you stand out:

• Demonstrated experience leading complex analytics-driven pharmacy audits.
• A growth- and innovation-oriented mindset with a track record of improving processes tools or methodology and/or supporting business development.
• Strong leadership presence with the ability to mentor and elevate others while staying hands-on in audit execution.
• Advanced degree PharmD RPh MBA CPA or other relevant credential.
• Experience with specialty pharmacy Medicare Part D or broader PBM financial performance audits.
• Prior experience formally managing or supervising staff.

Why join our team:

• We help you be your best through professional development opportunities interesting work and supportive leaders.
• We foster a vibrant and inclusive culture where you can work with talented colleagues to create new solutions and have an impact for colleagues clients and communities.
• Our scale enables us to provide a range of career opportunities as well as benefits and rewards to enhance your well-being.

Marsh (NYSE: MRSH) is a global leader in risk reinsurance and capital people and investments and management consulting advising clients in 130 countries. With annual revenue of over $27 billion and more than 95000 colleagues Marsh helps build the confidence to thrive through the power of perspective. For more information visit or follow us on LinkedIn and X.

Marsh is committed to embracing a diverse inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age background disability ethnic origin family duties gender orientation or expression marital status nationality parental status personal or social status political affiliation race religion and beliefs sex/gender sexual orientation or expression skin color veteran status (including protected veterans) or any other characteristic protected by applicable law. If you have a need that requires accommodation please let us know by contacting

Marsh is committed to hybrid work which includes the flexibility of working remotely and the collaboration connections and professional development benefits of working together in the office. All Marsh colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one anchor day per week on which their full team will be together in person.

The applicable base salary range for this role is $102500 to $204500.

The base pay offered will be determined on factors such as experience skills training location certifications education and any applicable minimum wage requirements. Decisions will be determined on a case-by-case addition to the base salary this position may be eligible for performance-based incentives.

We are excited to offer a competitive total rewards package which includes health and welfare benefits tuition assistance 401K savings and other retirement programs as well as employee assistance programs.

Required Experience:

Contract