Consultant: Medical Claim Auditor

Consultant: Medical Claim Auditor

Gallagher

Base pay range $51,000.00/yr - $99,500.00/yr

Introduction At Gallagher Benefit Services, youre a trusted partner to organizations navigating some of their most important people decisions. We help clients build better workplaces, where people feel supported, empowered, and inspired to thrive. Whether its shaping benefit strategies, designing wellbeing programs, or advising on workforce challenges, the work you do here creates meaningful change for businesses and the people who power them. Were a community of bold explorers, trusted experts, and compassionate partners; working side by side to solve problems, and shape the future of work. Here, curiosity is encouraged, collaboration is second nature, and your ideas have room to grow. If youre looking for a place where your contribution matters and where you can help build a better world of work; think of Gallagher.

Responsibilities

• Perform audits for any healthcare plan (i.e., medical, dental, vision, behavioral health), pre/post implementation audits and special projects as assigned.
• Review and understand all aspects of a clients benefit plan and corresponding documents.
• Review and evaluate the Administrative Services Agreement between the employer and Administrator.
• Evaluate the results of the initial claim data (Electronic Risk Assessment) and determine 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.
• If needed, travel to the Administrator to conduct on?site claim audit (occasional travel may be required).
• Collaborate with Administrator and senior consultants to resolve exceptions, review supporting documentation and make final claim error determinations.
• Ensure audit timelines are adhered to and deliver high level of service to clients.
• Prepare and present detailed audit reports that clearly articulate 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, webinar sessions, etc.
• Interact directly with clients, respond to client requests, and develop strong relationships with clients.

About You

Required: Bachelors degree and 5 or more years client coordination and/or claims management experience, OR high school degree with 3 or more years experience.

Preferred:

• 1-3 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 is a strong plus.
• Proficiency in Microsoft Office suite (Word, Excel, PowerPoint).
• Excellent oral and written communication skills.
• 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, requiring little supervision and able to manage multiple projects effectively to meet deadlines.
• Team player with a strong work ethic.

Compensation & Benefits

We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low and high end for this position. Compensation will be influenced by experience, education, location, scope, and skill set.

Minimum core benefits:

• Medical/dental/vision plans, starting 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).
• Training programs.
• Gallagher Thrive program elevating your health through challenges, workshops, and digital fitness programs.
• Charitable matching gift program.
• And more

Benefits summary above applies to full?time positions. If you are not applying for a full?time position, details about benefits will be provided during the selection process.

Inclusion and Diversity

We value inclusion and diversity. Gallagher believes all persons are entitled to equal employment opportunity. We prohibit discrimination on any protected characteristics by applicable laws. Equal employment opportunity will be extended in all aspects of the employer?employee relationship. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations unless it would impose an undue hardship on the operation of the business.

Seniority level

Not applicable

Employment type

Full?time

Job function

Health Care Provider

Industries: Insurance

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