Pharmacy Audit Data Analyst

• 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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