We are seeking a talented individual to join our Health & Benefits team at Mercer. 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 Audit Lead 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:
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.
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.
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