Pharmacy Audit Lead Consultant

About the role

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.

Responsibilities

• 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.

Requirements

• Bachelor's 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.

Qualifications

• 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.

Benefits

• Health and welfare benefits
• Tuition assistance
• 401K savings and other retirement programs
• Employee assistance programs

Pay

The applicable base salary range for this role is $102,500 to $204,500. 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 basis. In addition to the base salary, this position may be eligible for performance-based incentives.