Medical Claims Consultant

2 days ago


St Louis, Missouri, United States Gallagher Full time
About the Role

We are seeking a highly skilled Medical Claims Consultant to join our team at Gallagher. 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.
  • Evaluate the results of initial claim data and determine valid audit samples for review and response by the administrator.
  • Work with the data analytics team to define and translate plan provisions for testing purposes.
  • Travel to the administrator to conduct on-site claim audits.
  • Collaborate with the administrator to resolve exceptions, review supporting documentation, and make final claim error determinations.
  • Ensure audit timelines are adhered to and deliver high levels of service to clients.
  • Assist in supporting other auditors, managers, directors, and practice leaders as requested.
  • Prepare and present detailed audit reports that clearly articulate audit findings and recommendations.
Requirements
  • 5+ years of experience in medical claims consulting, auditing, or other applicable medical claims industry experience.
  • Demonstrated high level of medical claims or benefit administration knowledge, with Medicare experience a strong plus.
  • Proficient in the use of Microsoft Office suite of programs.
  • 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.
Preferred Qualifications
  • College degree (experience may be considered in waiving the degree requirement).
Benefits

We offer a wide range of benefits, including medical, dental, and vision plans, life and accident insurance, 401(K) and Roth options, tax-advantaged accounts, educational expense reimbursement, paid parental leave, and more.

We value inclusion and diversity and are committed to creating a workplace that is welcoming and inclusive of all employees. 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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