Sr. Consultant Medical Claim Auditor
Found in: Resume Library US A2 - 2 weeks ago
Buck, a Gallagher company, opens doors to a world of boundless opportunity and innovation. As part of our integrated team, you'll immerse yourself in the exciting journey of serving HR departments and trustees across diverse industries. Together, we'll build pathways to a brighter future for clients worldwide, harnessing the power of collective brilliance and shaping careers that ignite passions.
We believe that every candidate brings something special to the table, including you So, even if you feel that you’re close but not an exact match, we encourage you to apply.
Responsibilities:
A Sr. Consultant (Medical Claim Auditor) is expected to be a knowledgeable and reliable subject matter expert. The Medical Auditor is an integral part of the Medical Audit Team and is responsible for performing and supporting audits (medical, dental, vision, operational, Medicare, behavioral health, and pre/post-implementation, etc.) to validate that the coverage and payment of a claim are in compliance with the contractual, regulatory and custom plan guidelines. Sr. Consultants must show exemplary attention to detail, organizational skills, and an ability to manage time efficiently and handle changing or conflicting priorities. Sr. Consultants are positioned as project leaders on the delivery of internal initiatives and complex projects with responsibility for supporting growth through the following activities:
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 (Occasional travel is required to Administrator)
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 (apply acquired skills in client-productive ways).
Qualifications:
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.
Additional Information:
On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:
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
Other benefits include:
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
And more...
We value inclusion and diversity
to review our U.S. Eligibility Requirements
Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.
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