[Hiring] Medical Claim Auditor @Gallagher

Role Description

Responsible for leading complex pharmacy claim audits, ensuring compliance with client-specific requirements, and delivering advanced data analysis to identify trends, risks, and opportunities for improvement. This role involves:

• Managing high-risk audits
• Investigating fraud or discrepancies
• Presenting comprehensive reports with actionable recommendations
• Providing strategic insights through advanced data analysis, predictive modeling, and the development of sophisticated dashboards
• Managing senior-level client relationships
• Leading discussions on audit findings
• Collaborating on customized strategies to optimize pharmacy operations
• Mentoring junior team members
• Reviewing deliverables
• Driving team projects to enhance audit processes and tools
• Ensuring adherence to industry standards and providing guidance on regulatory compliance, including HIPAA
• Focusing on continuous improvement, innovation, and strategic initiatives to enhance client satisfaction, operational efficiency, and risk management

Qualifications

• Typically requires a University Degree or equivalent experience and minimum 5 years of prior relevant experience
• Proven experience in managing client relationships and delivering high-quality client services
• Strong background in pharmacy benefit management (PBM) processes and systems
• Extensive experience with data analysis tools (e.g., Excel, SQL, Tableau, Power BI)

Requirements

• Degree in Healthcare Administration, Business, Data Analytics, or a related field (preferred)
• Advanced analytical and problem-solving skills with the ability to interpret complex data sets
• Exceptional written and verbal communication skills, with the ability to present findings and recommendations to senior stakeholders
• Strong project management skills, with the ability to manage multiple priorities and meet deadlines
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and data visualization tools

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
• And more...