Under close supervision, conduct audits of the Customer Administration functional areas to assist in enhancing efficiencies and effectiveness in processing and identifying customer trends / suspicious transitions to reduce leakage and mitigate compliance risk. Such audits will be conducted with department leads and internal audit on occasions.
Essential Duties & Responsibilities: Percentage of Time
Under close supervision, conduct reviews of customer sales data to validate Customer payments, including but not limited to Rebates, Returns, Chargebacks, Medicaid Rebates, etc. in compliance with Contractual obligations and investigates anomalies in submitted claims; partner with Customer Administration Team members to address suspicious activity. Additionally, conduct analysis on indirect contract purchases for irregular trends and possible diversion.
Review suspect activity and partner with department management to determine corrective action and prepare data reports and trending analysis. Review and compare 867 to Chargebacks analysis for reasonability.
Work accurately to minimize errors, document assumptions, maintain accurate files and employ basic data management techniques to ensure data integrity.
Interact with internal customers in various departments and provide detailed analysis as requested, develop statistical reports, analyze data, and recommend solutions as well as provide scheduled & ad hoc financial reports & analysis to management and other duties as assigned.
Suggest new ideas for areas to audit / customer trends for review
Develop and foster relationships with internal and external customers and build a reputation for being credible, trustworthy, and fair.
Review 852 and 867 data from wholesalers and retailers to ensure upper management has accurate data for accruals, returns mitigation, forecasting, etc.
Other duties as assigned
High School Diploma or GED required
Bachelor’s Degree preferred
3+ years experience in claims processing, compliance, or contracting
Pharmaceutical industry experience
Manipulation of large data sets
Technical reading or contract interpretation
External client support/interaction
Specialized or Technical Knowledge, License, Certifications needed:
Advanced MS Excel skills
Functional Knowledge and skills:
Ability to work within a team
Committed to meeting deadlines
Demonstrate sense of urgency by effectively prioritizing workload according to organizational needs