We are seeking a Pharmacy Audit Data Analyst to join our Pharmacy Benefits Audit
team in our San Diego Health practice. In this role you will conduct data
analysis on pharmacy claims, financial guarantees, and rebates, translating
contract terms into data definitions, business rules, and testable audit logic
that quantify how PBMs are performing against their contracts. Day to day, you
will work hands-on in SQL with large claims data sets, build and monitor data
quality checks, and produce the reports and analytic deliverables that clients
and PBMs rely on to resolve disputes. This position may be performed remotely.
Who We Are
Independent for over 75 years, Milliman delivers market-leading services and
solutions to clients worldwide. Today, we are helping companies take on some of
the world’s most critical and complex issues, including retirement funding and
healthcare financing, risk management and regulatory compliance, data analytics,
and business transformation.
Milliman invests in skills training and career development and gives all
employees access to a variety of learning and mentoring opportunities. Our
growing number of Milliman Employee Resource Groups (ERG’s) are employee-led
communities that influence policy decisions, develop future leaders, and amplify
the voices of their constituents. We encourage our employees to give back to
their varied professions, including leadership in professional organizations.
Please visit our website (https://www.milliman.com/en/social-impact
[https://www.milliman.com/en/social-impact]) to learn more about Milliman’s
commitments to our people, inclusion, and sustainability.
Through a team of professionals ranging from actuaries to clinicians, technology
specialists to plan administrators, we offer unparalleled expertise in employee
benefits, investment consulting, healthcare, life insurance and financial
services, and property and casualty insurance.
What You Will Do
In this role, you will:
Perform audit testing of pharmacy claims data against contract terms,
including discount and dispensing fee pricing guarantees, administrative
fees, and other contractual financial guarantees
Write, troubleshoot, and optimize SQL queries in SQL Server Management Studio
(SSMS) 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 subject to testing.
Build and maintain validation checks to confirm data completeness and
accuracy before analysis begins.
Design, document, and implement new audit tests as contract terms, regulatory
requirements, and industry standards evolve.
Prepare client-ready exhibits and reports that clearly communicate audit
findings and financial impact.
Support the resolution process by researching PBM responses and rebuttals and
substantiating findings with claim-level detail.
Clearly identify and communicate data limitations and any findings that
cannot be validated with available information.
Communicate audit findings and data-driven recommendations directly to
clients, PBMs, and internal consultants through clear reports and exhibits at
key points in the audit lifecycle.
Respond to ad hoc data requests, including claims data monitoring and one-off
data pulls, analyses, or exhibits requested by clients and consultants.
Contribute to process improvements, automation, and the development of
internal audit tools and templates.
What We Are Looking For
Professional Qualifications
Bachelor's degree, preferably in math, health, science, or business
discipline
2-6 years of relevant experience that includes:
Health insurance, Pharmacy benefit design, or PBM industry experience
(PBM, health plan, insurance, consulting, or pharmacy operations)
Working knowledge of pharmacy benefit concepts, including
copays/coinsurance, AWP-based pricing, MAC, brand and generic
classification, specialty drugs, formulary design, and rebates
Demonstrated ability to write and troubleshoot SQL queries; experience with
SQL Server Management Studio 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
Personal Qualifications
Ability to explain technical terms, data, and analytic concepts in clear,
plain language to non-technical audiences, including clients and vendors
Exceptional attention to detail and accuracy
Intellectual curiosity and a willingness to question results
Effective written and verbal communication skills
Ownership, accountability, and critical thinking
Required
Individual(s) must be legally authorized to work in the United States without
the need for immigration support or sponsorship from Milliman now or in the
future.
The Team
The San Diego Health practice includes employees with diverse areas of
experience and expertise in the pharmacy space. Current employees include those
that have worked as actuaries, PBM analysts/consultants, pharmacists, and
pharmacy technicians.
Location
The expected application deadline for this job is October 22, 2026.
This role is based out of the Milliman office in San Diego, CA, but candidates
hired into this role may work remotely anywhere in the US or onsite if they
prefer.
Compensation
The overall range for this role is $59,200 - $109,020. For candidates residing
in:
Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New
Jersey, New York City, Pennsylvania, Virginia, Washington, or the District of
Columbia the range is $68,080 - $109,020.
All other locations the range is $59,200 - $94,800.
A combination of factors will be considered, including, but not limited to,
education, relevant work experience, qualifications, skills, certifications,
etc.
Benefits
We offer a comprehensive benefits package designed to support employees’ health,
financial security, and well-being. Benefits include:
Medical, Dental and Vision – Coverage for employees, dependents, and domestic
partners.
Employee Assistance Program (EAP) – Confidential support for personal and
work-related challenges.
401(k) Plan – Includes a company matching program and profit-sharing
contributions.
Discretionary Bonus Program – Recognizing employee contributions.
Flexible Spending Accounts (FSA) – Pre-tax savings for dependent care,
transportation, and eligible medical expenses.
Paid Time Off (PTO) – Begins accruing on the first day of work. Full-time
employees accrue 15 days per year, and employees working less than full-time
accrue PTO on a prorated basis.
Holidays – A minimum of 10 paid holidays per year.
Family Building Benefits – Includes adoption and fertility assistance.
Paid Parental Leave – 11 weeks of paid leave for employees who meet
eligibility criteria.
Life Insurance & AD&D – 100% of premiums covered by Milliman.
Short-Term and Long-Term Disability – Fully paid by Milliman.
Equal Opportunity
All qualified applicants will receive consideration for employment, without
regard to race, color, religion, sex, sexual orientation, national origin,
disability, or status as a protected veteran.
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