PBM Auditor
PBM Auditor
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Job Description
ABOUT US
At HUB International we are a team of entrepreneurs. We believe in protecting and supporting the aspirations of individuals families and businesses. We help our clients evaluate their risks and develop solutions tailored to their needs. We believe in empowering our employees to learn grow and make a difference. Our structure enables our teams to maintain their own unique regional culture while leveraging support and resources from our corporate centers of excellence.
HUB is a global insurance and employee benefits broker providing a boundaryless array of business insurance employee benefits risk services personal insurance retirement and private wealth management products and services. With over $5 billion in revenue and almost 20000 employees in 600 offices throughout North America HUB has grown substantially in part due to our industry leading success in mergers and acquisitions.
ABOUT THE ROLE
Summary:
The PBM Auditor is responsible for conducting comprehensive audits of Pharmacy Benefit Managers (PBMs) to ensure contractual compliance accurate claims processing and proper financial management. This role involves in-depth data analysis contract interpretation and the preparation of detailed reports and findings. The PBM Auditor works to identify discrepancies recoup overpayments and provide recommendations to optimize pharmacy benefit programs.
Key Responsibilities:
Conduct PBM Audits: Plan execute and manage all aspects of PBM audits including claims data analysis financial reviews and compliance checks against contract terms.
Contract Review and Interpretation: Thoroughly analyze PBM contracts including pricing guarantees rebates and administrative fees to ensure the PBM is adhering to all agreed-upon terms and conditions.
Claims Data Analysis: Utilize data analytics tools to review large datasets of prescription claims identifying patterns and anomalies related to pricing formulary compliance and proper adjudication.
Financial Reconciliation: Verify the accuracy of financial guarantees payments and rebates and calculate potential recoupment amounts for any identified overcharges or errors.
Reporting and Communication: Prepare detailed audit reports summarizing findings including discrepancies financial impact and recommendations for improvement. Present these findings to internal and external stakeholders.
Regulatory Compliance: Ensure that all auditing processes and PBM activities comply with relevant state and federal regulations
Collaboration: Work closely with other departments such as legal data analytics and client management teams to address complex audit issues.
Process Improvement: Identify and recommend opportunities to enhance audit processes improve efficiency and develop new auditing methodologies.
Required Qualifications:
Education: A Bachelors degree in Business Finance Healthcare Administration or a related field. A pharmacy degree (Pharm.D.) or a background as a Certified Public Accountant (CPA) is often a plus.
Experience: A minimum of 3-5 years of experience in the PBM industry healthcare claims auditing or a related field. Direct experience with PBM audits is highly preferred.
Technical Skills:
- Proficiency in data analysis tools such as Microsoft Excel (advanced functions) and SQL.
- Familiarity with PBM platforms and claims adjudication systems.
- Strong understanding of pharmacy billing and operational practices.
- Knowledge: In-depth knowledge of PBM contracts pricing models (e.g. AWP MAC) and rebate methodologies.
- Comprehensive understanding of pharmacy benefit design including formularies copays and prior authorizations.
- Knowledge of relevant healthcare regulations and compliance requirements.
Soft Skills:
- Excellent analytical and problem-solving abilities with a strong attention to detail.
- Exceptional written and verbal communication skills with the ability to present complex information clearly and concisely.
- Strong organizational and time management skills to handle multiple projects and deadlines.
- Ability to work independently and collaboratively in a team environment.
JOIN OUR TEAM
Do you believe in the power of innovation collaboration and transformation Do you thrive in a supportive and client focused work environment Are you looking for an opportunity to help build and drive change in a rapidly growing and evolving organization When you join HUB International you will be part of a community of learners and doers focused on our Core Values: entrepreneurship teamwork integrity accountability and service.
Disclosure required under applicable law in California Colorado Illinois Maryland Minnesota New York New Jersey and Washington states: The expected salary range for this position is $140K to $180Kand will be impacted by factors such as the successful candidates skills experience and working location as well as the specific positions business line scope and level. If you believe that your qualifications and experience surpass the minimum requirements for this role we encourage you to submit your application. By doing so we will be able to keep your application on file for consideration for potential future positions within our organization. HUB International is proud to offer comprehensive benefit and total compensation packages which could include health/dental/vision/life/disability insurance FSA HSA and 401(k) accounts paid-time-off benefits such as vacation sick and personal days and eligible bonuses equity and commissions for some positions.
Department Account Management & ServiceRequired Experience: 2-5 years of relevant experienceRequired Travel: Up to 25%Required Education: Bachelors degree (4-year degree)HUB International Limited is an equal opportunity employer that does not discriminate on the basis of race/ethnicity national origin religion age color sex sexual orientation gender identity disability or veterans status or any other characteristic protected by local state or federal laws rules or regulations.
We endeavor to make this website accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process please contact the recruiting team. This contact information is for accommodation requests only; do not use this contact information to inquire about the status of applications.
Employment Type
Full-Time
