Gallagher · 15 hours ago
Pharmacy Auditor
Kansas City, MO
Full-time
Hybrid
Senior Level, Lead/Staff
$75K/yr - $146K/yr
10+ years expGallagher Benefit Services is a trusted partner to organizations navigating important people decisions. The Pharmacy Auditor is responsible for performing and supporting Prescription Drug Claim Audits to ensure compliance with contractual and regulatory guidelines, while managing client expectations and multiple projects effectively.
ConsultingFinancial ServicesInsuranceManagement ConsultingRisk Management
Responsibilities
Project management of Prescription Drug Claim Audits from implementation through closure
Manage and perform audits of prescription drug claim payment data to validate conformance with contractual requirements and plan specifications as assigned
Review and evaluate Administrative Services Agreement between the employer and PBM
Work with dedicated data analytics team to define and translate plan provisions for testing purposes, ensuring that scope aligns with the statement of work and client commitments. Review client-specific documentation, Summary Plan Description(s), and other documentation such as copay grids, plan literals, set-up grids, etc., to develop the audit test filters
Complete the contract summary, or assist with completion of contract summaries, as assigned
Evaluate the results of the initial claim data tests and determine valid audit samples for review and response by the PBM
Prepare PBM communications regarding test results, response expectations, and clarifications to questions
Work collaboratively with PBM to resolve exceptions, review supporting documentation, and make final claim error determination
Ensure audit timeline is adhered to and deliver high level of service to clients
Perform Prescription Drug Claim Rebate audits as assigned. (Occasional travel to the PBM is required; 10-20% travel possible.)
Prepare and present detailed audit reports which clearly articulate audit findings and recommendations to PBM and client
Maintain audit project work papers to support audit findings
Work collaboratively within the audit team, as well as with internal and external customers
Participate in team meetings, conference calls, Microsoft Teams meetings, etc. remotely with PBMs and audit team as necessary
Assist with claims data analysis and quality assurance as requested
Interact directly with clients and respond to client requests. Develop strong relationships with clients
Assist in supporting other auditors, Manager, Director, and Practice Leader as requested. Provide leadership and/or mentorship to less senior members of the audit team
Perform special projects or assignments, as instructed by Manager
Attain billable hours objective (apply acquired skills in client-productive ways)
Qualification
Required
College degree (experience may be considered to waive the degree requirement)
10+ years' experience in pharmacy auditing, consulting, or other applicable pharmacy industry experience
Previous PBM experience is a plus but not required
Must demonstrate a high level of pharmacy benefit, claim, or benefit administration knowledge - Medicare benefits experience is a strong plus
Proficient in the use of Microsoft Office Suite of programs (Word, Excel, PowerPoint, Outlook, Teams)
Excellent oral and written communication skills are required
Excellent organizational and time management skills
Personable communication style, positive outlook, leadership skills, and self-confidence
Ability to multi-task and acclimate to changing priorities without losing focus
Attention to detail and ability to clearly explain thought process in reaching documented conclusions
Self-directed individuals who require little supervision and can manage multiple projects effectively to ensure deadlines are met
Team player with a strong work ethic
Benefits
Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program
And more...
Company
Gallagher
Gallagher is an international insurance brokerage and risk management services firm.
10001+ employees
H1B Sponsorship
Gallagher has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (58)
2024 (31)
2023 (32)
2022 (45)
2021 (36)
2020 (15)
Funding
Current Stage
Public CompanyTotal Funding
$9.7B2024-12-09Post Ipo Equity· $8.5B
2023-06-22Post Ipo Debt· $1.2B
1984-06-29IPO
Leadership Team
Alec Herring
Area Senior Vice President
Mark Gresser
Executive Vice President
Recent News
Life Insurance International
2026-01-07
2025-12-04
2025-11-19
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