ZipRecruiter

Log In

1

Pharmacy Audit Pbm Jobs (NOW HIRING)

Scangroup

Manager, Pharmacy Operations

Long Beach, CA · On-site

... PBM) on CMS, DHCS, and other states regulatory requirements. The role ensures regulatory compliance ... Ensure audit documentation is prepared according to audit instructions and provided within the ...

SCAN Group

Manager, Pharmacy Operations

Long Beach, CA · On-site

... PBM) on CMS, DHCS, and other states regulatory requirements. The role ensures regulatory compliance ... Ensure audit documentation is prepared according to audit instructions and provided within the ...

Actalent

Remote Pharmacy Technician

$18 - $23/hr

... audit and recovery, pharmacy service center activities, Medicare Part D and Part B processes ... Proficiency in using databases and systems, including updating Access databases and PBM systems.

Actalent

Remote Pharmacy Technician

$18 - $23/hr

... audit and recovery, pharmacy service center activities, Medicare Part D and Part B processes ... Proficiency in using databases and systems, including updating Access databases and PBM systems.

Judi Health

Case Development Specialist

Charlotte, NC · On-site

Experience in an administrative, healthcare, PBM, insurance, pharmacy, compliance, audit, investigative, or related environment preferred. * Strong organizational skills with exceptional attention to ...

Alivia Health

PR · On-site

... pharmacy. This role focuses primarily on reviewing and validating payments, identifying ... The analyst's primary responsibility is to audit, document, and report findings to the teams.

next page

Showing results 1-20

All JobsHealthcare JobsMedical Specialists JobsPharmacy Aide JobsPharmacy Audit Pbm Jobs

Pharmacy Audit Pbm information

See salary details

$14

$19

$26

How much do pharmacy audit pbm jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for pharmacy audit pbm in the United States is $19.27, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $20.43 per hour, depending on experience, location, and employer.

What is a Pharmacy Audit PBM?

A Pharmacy Audit PBM refers to the process where a Pharmacy Benefit Manager (PBM) reviews and evaluates a pharmacy’s claims, records, and compliance with contractual and regulatory requirements. These audits are designed to ensure that pharmacies are billing correctly, following formulary guidelines, and maintaining proper documentation. The goal is to detect and prevent fraud, waste, and abuse in the prescription drug benefit process. Pharmacies may be audited on-site or through desk audits, and findings can impact reimbursement or network participation.

What are the key skills and qualifications needed to thrive as a Pharmacy Audit PBM?

To thrive as a Pharmacy Audit PBM (Pharmacy Benefit Manager), you need strong analytical skills, attention to detail, and a background in pharmacy, healthcare, or auditing, often supported by a relevant degree or pharmacy technician certification. Familiarity with pharmacy claims processing systems, PBM platforms, and auditing software is essential. Critical thinking, effective communication, and problem-solving abilities are key soft skills for identifying discrepancies and collaborating with pharmacies and internal teams. These skills ensure accurate audits, regulatory compliance, and cost savings in the complex PBM environment.

What are some typical challenges faced by professionals in Pharmacy Audit PBM roles, and how can they be managed?

Professionals in Pharmacy Audit PBM (Pharmacy Benefit Management) roles often encounter challenges such as staying updated with constantly evolving pharmacy regulations, analyzing large volumes of complex claims data, and ensuring audit accuracy within tight deadlines. Managing these challenges requires strong analytical skills, attention to detail, and the ability to quickly interpret regulatory changes. Collaboration with pharmacists, IT teams, and compliance officers is also essential to resolve discrepancies and implement process improvements effectively.

What is the difference between Pharmacy Audit Pbm vs Pharmacy Claims Processor?

AspectPharmacy Audit PbmPharmacy Claims Processor
CertificationsPharmacy Technician Certification, PBM-specific trainingPharmacy Technician Certification, Claims processing training
Work EnvironmentPBM offices, healthcare plans, pharmacy benefit management companiesPharmacies, healthcare providers, insurance companies
Employer & Industry UsagePrimarily in PBMs and pharmacy benefit management industryIn pharmacies and insurance companies handling claims

Pharmacy Audit Pbm professionals focus on auditing pharmacy claims within PBMs to ensure compliance and accuracy, while Pharmacy Claims Processors handle the submission and processing of pharmacy claims. Both roles require similar certifications but differ in their primary responsibilities and work environments.

More about Pharmacy Audit Pbm jobs

What cities are hiring for Pharmacy Audit Pbm jobs?

Cities with the most Pharmacy Audit Pbm job openings:

What states have the most Pharmacy Audit Pbm jobs?

States with the most job openings for Pharmacy Audit Pbm jobs include:

What job categories do people searching Pharmacy Audit Pbm jobs look for?

The top searched job categories for Pharmacy Audit Pbm jobs are:

Pharmacy Audit Pbm jobs near you
Infographic showing various Pharmacy Audit Pbm job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 1% As Needed, 69% Full Time, 27% Part Time, and 2% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $40,074 per year, or $19.3 per hour.

Health Data Analyst (Pharmacy Claims Audit) - Remote

Prime Therapeutics

Remote

$66K - $106K/yr

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Prime Therapeutics rating

7.9

Company rating: 7.9 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

16th of 113 rated pharmacies

Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
Health Data Analyst (Pharmacy Claims Audit) - RemoteJob Description
The Health Data Analyst provides information, analyses, and consultation to internal and external stakeholders. This position assesses the performance of pharmacy benefits and/or networks and develops recommendations for improvements or enhancement to support departmental and organizational objectives. This position will participate in the development of new reports, analytical models, and products/benefit programs that align with Prime's strategic imperatives.
Responsibilities
  • Assumes responsibility for moderately complex analytic and consultative work such as analyzing and interpreting client pharmacy benefit data, trends and reports and partnering with analytics team to deliver recommendations or project status updates to internal and external stakeholders; investigates follow up items or questions regarding project and/or request scope
  • Investigates key drivers of benefit performance
  • Create new queries using SASEG including multiple table joins, understanding of table structures, creation of detailed formulas leveraging an understanding of SAS code
  • Participates in development of analytic methodologies, models, reports and new products
  • May be responsible for Centers for Medicaid/Medicare Services reporting and analysis, including the management of directories and bid support
  • Other duties as assigned

Minimum Qualifications
  • Bachelor's degree in Mathematics, Finance, or related field, or the equivalent combination of education and/or relevant work experience; HS diploma or GED is required
  • 2 years of experience in pharmacy benefits management, reporting & analytics, benefits consulting, healthcare, financial services or related field
  • Must be eligible to work in the United States without need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
  • Advanced Microsoft Excel skills - ability to create complete formulas and efficient data manipulation.
  • Extensive experience using analytic tools; familiarity with Alteryx and Cognos
  • Experience working with pharmacy audit and/or fraud waste, and abuse
  • Intermediate troubleshooting skills, including in-depth client data research, which may involve research and drivers of utilization; understands resources needed and steps/processes on how to complete the problem; able to understand when an issue arises how-to navigate to a resolution
  • Strong PBM industry knowledge; able to articulate the industry trends to clients and the impact of trends and changes to client financials
  • Ability to establish rapport and effectively influence at all levels within an organization
  • Ability to communicate effectively and present complex data to a wide variety of audiences

Preferred Qualifications
  • Knowledge of the PBM (Pharmacy Benefit Management) industry and PBM data; understands key PBM metrics (such as PMPM, generic utilization)
  • Experience working with large sets of pharmacy, claims, medical, and/or financial data
  • Previous experience in a client facing or consultative role
  • Extensive experience using analytic tools; familiarity with SAS EG

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.

What Prime Therapeutics employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Prime Therapeutics logo

About Prime Therapeutics

Sourced by ZipRecruiter

Prime Therapeutics, located in Eagan, MN, is a pharmacy benefits management company that has been serving the healthcare industry since its foundation. They are an integral participant in the medical sector, specifically in the realm of health insurance. They focus on providing innovative pharmacy benefits and services to more than 30 million members nationwide. Besides their main pharmacy benefit management, they offer mail service pharmacy, specialty pharmacy, benefits management, and consultative engagement services to ensure individuals have continuous access to affordable prescription drugs. Prime Therapeutics, founded around three decades ago, has grown to stand out as a leader in its industry, thanks to its commitment to improving the health of its clients.

Industry

Insurance services

Company size

1,001 - 5,000 Employees

Headquarters location

Eagan, MN, US

Year founded

1987

Social media

FacebookTwitter

View All Prime Therapeutics Jobs

Apply