Director - PBM Contract Audit

3 days ago

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EPIC Insurance Brokers & Consultants

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EPIC Insurance Brokers & Consultants is a leading insurance brokerage and consulting firm that specializes in providing comprehensive insurance solutions and risk management services to businesses and individuals. With a focus on innovation and customer service, EPIC leverages its expertise to help clients navigate the complex insurance landscape and ensure they have the right coverage for their needs. The firm operates with a commitment to its core values of integrity, excellence, and teamwork, striving to deliver exceptional value to every client.

Risk Management Services • Employee and Executive Benefits Consulting • Property & Casualty Insurance Brokering • Private Client Services and Individual Risk Management • Claims Management and Advocacy

1001 - 5000 employees

🤝 B2B

💰 Seed Round on 2007-01

📋 Description

• Managing timelines and deliverables of the team in a fast-paced environment • Manage & Mentor team of seasoned auditors • Prepares and executes a resource capacity plan and resource schedules • Support audit business development opportunities and marketing content • Establish and maintain key relationships with internal executives and external stakeholders (clients and vendors) • Subject matter expert with deep understanding and knowledge of PBM contracts and terms • Utilize PSG’s proprietary Compliance Model • Document all potential issues and track decisions including escalations • Collaborate with account management and pharmacy consultants to discuss and present results with clients and vendors • Work with IT to further develop Compliance Model logic and capabilities • Assist in other financial projects as needed

🎯 Requirements

• Bachelor’s degree in Business, Finance, or a health-related field • 5 years of leadership experience • At least 7 years of either a) pharmacy benefit audit or b) claim adjudication research experience on one or more PBM platforms • Working knowledge of the PBM industry and pharmacy benefit claims • Proficient in Microsoft Office, with extensive experience working with Excel • Proficient in SQL to extract data and build queries • Ability to effectively develop and maintain strong working relationships with internal and external stakeholders • Strong written and verbal communication skills and discipline to multitask and prioritize projects to meet scheduled deadlines • Strong analytical, problem-solving, organization, critical thinking, and time management skills • Excellent attention to detail and quality • Previous Medicare Part D experience preferred • Ability to interact with diverse group of stakeholders including executives, managers, clients, and subject matter experts both technical and non-technical • Solid, independent worker (work from home) • Ability for some travel (5% - 10%)

🏖️ Benefits

• Generous Paid Time off • Generous leave time options: Paid parental leave, pregnancy disability and bonding leave, and organ donor/bone marrow donor leave • Generous employee referral bonus program of $1,500 per hired referral • Employee recognition programs for demonstrating EPIC’s values plus additional employee recognition awards and programs (and trips!) • Employee Resource Groups: Women’s Coalition, EPIC Veterans Group • Professional growth & development: Mentorship Program, Tuition Reimbursement Program, Leadership Development • Unique benefits such as Pet Insurance, Cancer Insurance, Identity Theft & Fraud Protection Coverage, Legal Planning, Family Planning, and Menopause & Midlife Support • Additional benefits include (but are not limited to): 401(k) matching, medical insurance, dental insurance, vision insurance, and wellness & employee assistance programs • 50/50 Work Culture: EPIC fosters a 50/50 culture between producers and the rest of the business, supporting collaboration, teamwork, and an inclusive work environment. It takes both production and service to be EPIC! • EPIC Gives Back – Some of our charitable efforts include Donation Connection, Employee Assistance Fund, and People First Foundation • We’re in the top 10 of property/casualty agencies according to “Insurance Journal”