Pharmacy Benefits Audit Operations Analyst

Description

We are seeking a Pharmacy Benefits Audit Operations Analyst to join our Pharmacy Benefits Audit team in our San Diego Health practice. This position may be performed remotely. The analyst will support 20 or more concurrent audit and consulting engagements by analyzing pharmacy claims, eligibility, rebate, and pricing data using Excel and SQL, and by coordinating project schedules, data requests, and deliverables with clients, PBMs, and other vendors. This role requires strong organizational, communication, and follow-through skills.

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 web site (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:

• Load, clean, and validate claims, eligibility, pharmacy, and rebate data received from PBMs, clients, and other vendors
• Write and modify basic SQL queries and excel models to summarize claims data, reconcile totals to PBM reporting, and prepare exhibits for consultant review
• Manage the day-to-day execution of 20 or more concurrent audit and client engagements, maintaining project schedules, milestones, and deliverable due dates.
• Work with clients, PBMs, third-party administrators, carriers, and other vendors to resolve open data and report questions that arise during an audit
• Prepare audit data requests, track PBM and client responses, and escalate delays that place timelines at risk.
• Lead internal and client working sessions, including agendas, meeting notes, action items, and follow-up.
• Track workload and capacity across consultants and analysts to align staffing with project demand.
• Review deliverables for completeness, consistency, and formatting prior to client release.

What We Are Looking For

Professional Qualifications

• Bachelor's degree or equivalent combination of education and experience
• 2+ years of relevant experience in data analysis, project management, consulting, or a related field preferred
• Pharmacy benefits or PBM industry experience preferred
• PMP, CAPM, or pharmacy-specific credentials (e.g., CPhT) preferred
• Demonstrated ability to manage multiple concurrent projects and competing deadlines with limited oversight
• Experience interacting directly with clients, vendors, or senior stakeholders
• Proficiency in Excel, PowerPoint, Outlook, Planner, OneNote and other project management or task-tracking systems
• Strong written and verbal communication skills, including clear and professional client correspondence and comfort presenting to leadership
• Familiarity with claims data or basic SQL a plus

Personal Qualifications

• Highly organized with consistent follow-through
• Independent judgment and decision-making
• Ownership and accountability
• Collaborative approach 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 $78,800 - $145,130. 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 $90,620 - $145,130.
• All other locations the range is $78,800 - $126,200.

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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