Come join our team of experts and manage the marketing, execution and delivery of benefits claims audits (medical and pharma).
Provide strategic guidance to clients and maximize the Company’s revenue and profitability potential.
The Senior Consultant will manage client audits of the administration and adjudication of benefit payments for medical, pharmacy, dental or dependent eligibility.
As the Trusted Advisor to our clients, the Senior Consultant anticipates the needs of our clients and effectively navigates project management and multiple competing priorities.
Key responsibilities include but may not limited to:
Strategic consultant for claims audits and counsel to clients
Develop, price, present and manage audit proposals for clients
Advise on industry best practices and manage electronic audits
Summarize and present findings and recommendations to clients
10+ years of health care claims analysis experience with data-driven analytics and financial reporting expertise preferably within a claims payer and/or benefits consulting environment
Extensive knowledge of employee benefit claims processing operational and adjudication procedures to include codes related to medical and dental claims (i.e., ICD, CPT, CDT, HCPCS, Revenue codes, etc.) and identification of coding inconsistencies
Claims administration and/or audit experience to include significant exposure to and expertise in electronic audit functions to include systems and tools relevant to an independent/third-party audit process
Familiarity with fraud detection measures and controls
Expert demonstrated proficiency level in use of Access, Excel, Word, PowerPoint and claims processing systems
Demonstrated project management, multi-tasking skills and ability to work within a fast-paced, deadline-driven environment
CEBS certification helpful
Strong technical/analytical, problem solving and writing (oral/written) skills
Affirmative Action/Diversity Inclusion: At Segal, we are committed to a culture of diversity and inclusiveness, as demonstrated through our recruitment, retention and employee development programs. We maintain an environment that respects and builds on the assets and talents of each person, valuing their differences. We also engage in good faith efforts to maintain an environment free from discrimination and harassment in strict compliance with applicable laws, and consider all qualified candidates for employment without regard to their race/ethnicity, national origin, color, religion, gender, sexual orientation, gender identity or expression, age, disability or medical condition, protected veteran or military status, criminal record history, marital status, or status in any group or class protected by applicable federal, state or local law. We also engage in affirmative action to employ and advance in employment qualified women, minorities, disabled individuals and protected veterans. Maintaining a diverse and inclusive workforce is a win/win, and provides Segal with the opportunity to leverage our top talent to provide innovative solutions to our clients.
Internal Number: SP00000049
About The Segal GRoup
For over 80 years, Segal has been providing employee benefits and human resources consulting for multiemployer trust funds, corporations and public sector organizations. Segal is an independent, privately and employee-owned firm. Our independence allows us to provide unbiased consulting services for our clients. Headquartered in New York City, Segal has offices throughout the United States and in Canada. We are a smaller organization that provides a more intense and broader exposure for development purposes within a culture that is highly collegial and team-oriented. You will work with colleagues who are smart, professional, talented and...nice people. We offer a competitive pay and benefits package that includes a Defined Benefit pension and matching 401(k) plans.