Medical Claims Consultant

6 days ago


St Louis, Missouri, United States GBS - Global Full time
About the Role

We are seeking a highly skilled Medical Claims Consultant to join our team at GBS - Global. As a key member of our Medical Audit Team, you will be responsible for performing and supporting audits to ensure compliance with contractual, regulatory, and custom plan guidelines.

Key Responsibilities
  • Manage and perform audits of medical, dental, vision, behavioral health, and pre/post-implementation claims.
  • Review and understand all aspects of a client's benefit plan and contractual agreements.
  • Work collaboratively with the data analytics team to define and translate plan provisions for testing purposes.
  • Travel to the Administrator to conduct on-site claim audits (occasional travel required).
  • Prepare and present detailed audit reports to the Administrator and Client.
Requirements
  • 5+ years' experience in medical claims consulting, auditing, or other applicable medical claims industry experience.
  • High level of medical claims or benefit administration knowledge - Medicare experience a strong plus.
  • Proficient in Microsoft Office suite of programs (Word, Excel, PowerPoint).
  • Ability to multi-task and acclimate to changing priorities without losing focus.
What We Offer

On top of a competitive salary, great teams, and exciting career opportunities, we also offer a wide range of benefits, including medical/dental/vision plans, life and accident insurance, 401(K) and Roth options, tax-advantaged accounts, educational expense reimbursement, paid parental leave, and more.

About Us

GBS - Global is a leading provider of benefits and insurance solutions. We value inclusion and diversity and are committed to creating a workplace where everyone feels valued and respected. We believe that all persons are entitled to equal employment opportunity and prohibit any form of discrimination based on protected characteristics.



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