Role Overview/Purpose
The Chargebacks Analyst is responsible for the timely and accurate administration, validation, reconciliation, and resolution of pharmaceutical chargeback claims submitted by wholesalers and distributors. The role ensures claims are adjudicated in accordance with contract pricing, customer eligibility requirements, membership affiliations, and company policies while supporting financial accuracy across Commercial Operations.
The position works closely with Contracts, Membership, Pricing, Customer Service, Accounts Receivable, Finance, Gross-to-Net (GTN), Sales, and IT teams supporting chargeback operations, customer eligibility management, deduction resolution, and reporting activities. The Analyst also contributes to process improvements, reporting enhancements, system initiatives, and operational efficiencies that strengthen Commercial Operations performance.
Overall Job Responsibilities
- Process, validate, and adjudicate chargeback submissions, resubmissions, credit/debit rebills, and disputed transactions in Model N in accordance with contract terms and company policies.
- Review chargeback claims against contract pricing, WAC, customer eligibility, product eligibility, membership status, and applicable effective dates to ensure accurate claim adjudication.
- Reconcile chargeback activity across Model N, SAP, EDI transactions, wholesaler submissions, customer deductions, credit memos, and related financial systems to ensure financial and operational accuracy.
- Investigate pricing discrepancies, deductions, disputed claims, and transaction variances; identify root causes and coordinate timely resolution with wholesalers and internal stakeholders.
- Partner with Accounts Receivable to resolve deduction-related issues, support credit applications, reconcile balances, and assist with dispute resolution activities.
- Support customer eligibility and membership management activities, including GPO, IDN, 340B, DEA, HIN, customer master maintenance, and contract alignment.
- Maintain current knowledge of active contracts, amendments, pricing updates, membership changes, and customer affiliations impacting chargeback processing.
- Prepare and analyze monthly, quarterly, and annual chargeback reports and KPIs, including processing accuracy, rejection trends, deduction aging, dispute activity, and customer-specific variances.
- Perform trend, variance, and root-cause analysis to identify recurring issues, financial exposure, process improvement opportunities, and enhancements to first pass claim accuracy.
- Support month-end close activities, GTN accrual validation, financial reconciliations, audits, and management reporting requirements.
- Participate in Model N upgrades, system enhancements, UAT testing, validation, and implementation activities, including execution of test scenarios and verification of results.
- Support reporting automation, business process improvements, and operational efficiency initiatives utilizing Power BI, Power Automate, SharePoint, Microsoft Teams, and other available technologies.
- Maintain process documentation, standard operating procedures, business rules, and workflow documentation to support compliance and operational consistency.
Desired Experience and Knowledge
Educational Knowledge:
- Bachelors degree in business, Finance, Accounting, Economics, Data Analytics, or a related discipline.
- Equivalent combinations of education and relevant experience may be considered.
Experience:
- 3-5 years of experience in pharmaceutical chargebacks, commercial operations, contracts administration, finance, revenue management, or a related field.
- Experience with pharmaceutical wholesalers, distributors, and high-volume transaction processing environments preferred.
- Experience with pharmaceutical chargeback adjudication, contract administration, customer eligibility management, membership operations, or Commercial Operations strongly preferred.
- Experience with Model N and SAP preferred.
- Experience with EDI transactions, including EDI 844 and EDI 849, preferred.
- Experience supporting deduction management, Accounts Receivable reconciliation, and dispute resolution activities preferred.
- Knowledge of Gross-to-Net (GTN) processes and pharmaceutical revenue management is a plus.
Knowledge and Skills (Functional and Technical):
- Strong understanding of pharmaceutical chargebacks, contract pricing, customer eligibility, membership management, and deductions.
- Advanced Microsoft Excel skills with the ability to analyze and reconcile large datasets.
- Experience with reporting and automation tools, including Power BI and Power Automate.
- Strong analytical, reconciliation, problem-solving, and decision-making skills.
- Excellent attention to detail and commitment to accuracy and quality.
- Strong organizational skills with the ability to manage multiple priorities and meet deadlines.
- Excellent written and verbal communication skills.
- Ability to effectively collaborate with internal teams, external customers, wholesalers, and business partners.
- Ability to work independently while exercising sound judgment and accountability.
- Fluent English communication skills, both written and verbal.
Ability to support U.S. business hours (approximately 5:00 AM - 1:00 PM EST)
