Sr. Consultant, Health & Medical Claim Auditor (US Remote)
About the position Responsibilities • Manage and perform retrospective and pre-implementation claim audits of healthcare plans such as medical, dental, vision and behavioral health. • Review and understand all aspects of a client's benefit plan. • Review and evaluate Administrative Services Agreement between the employer and Administrator. • Evaluate the results of the initial claim data (Electronic Risk Assessment) and identify valid audit samples for review and response by the Administrator. • Work with dedicated data analytics team to define and translate plan provisions for testing purposes ensuring that the scope of the audit is in line with the statement of work and client commitments. • Travel to the Administrator to conduct the on-site claim audit as needed. • Work collaboratively with Administrator to resolve exceptions, review supporting documentation and make final claim error determination. • Ensure audit timeline is adhered to and deliver high level of service to Clients. • Assist in supporting other auditors, Manager, Director, and Practice Leader as requested. • Prepare and present detailed audit reports which clearly articulate the audit findings and recommendations to the Administrator and Client. • Work collaboratively within the audit team as well as with internal and external customers. • Participate in team meetings, conference calls, WebEx's etc. • Interact directly with clients and respond to client requests, develop strong relationships with clients. • Attain billable hours objective. Requirements • College degree (experience may be considered in waiving the degree requirement). • 5+ years' experience in medical claims consulting, auditing, or other applicable medical claims industry experience. • Must demonstrate a high level of medical claims or benefit administration knowledge - Medicare experience a plus. • Proficient in the use of Microsoft Office suite of programs (Word, Excel, PowerPoint). • Excellent oral and written communication skills required. • Excellent organizational and time management skills. • Personable communication style, positive outlook, and self-confidence. • Ability to multi-task and acclimate to changing priorities without losing focus. • Attention to detail and ability to clearly explain thought process in reaching documented conclusions. • Self-directed individuals who require little supervision and can manage multiple projects effectively to ensure deadlines are met. • Team player with a strong work ethic. Benefits • Medical/dental/vision plans, which start from day one! • Life and accident insurance. • 401(K) and Roth options. • Tax-advantaged accounts (HSA, FSA). • Educational expense reimbursement. • Paid parental leave. • Digital mental health services (Talkspace). • Flexible work hours (availability varies by office and job function). • Training programs. • Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing. • Charitable matching gift program. Apply tot his job Apply tot his job