Medical Claim Auditor

Gallagher • Rolling Meadows, IL

5d

About The Position

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, and presenting comprehensive reports with actionable recommendations. The Senior Analyst/Auditor provides strategic insights through advanced data analysis, predictive modeling, and the development of sophisticated dashboards to support client decision-making and cost-saving initiatives. Acting as a trusted advisor, this role manages senior-level client relationships, leads discussions on audit findings, and collaborates on customized strategies to optimize pharmacy operations. Additionally, the position includes mentoring junior team members, reviewing deliverables, and driving team projects to enhance audit processes and tools. With expertise in regulatory compliance, including HIPAA, the Senior Analyst/Auditor ensures adherence to industry standards and provides guidance to clients and internal teams. This role also focuses on continuous improvement, innovation, and strategic initiatives to enhance client satisfaction, operational efficiency, and risk management.

Requirements

• University Degree or equivalent experience
• 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)
• Demonstrates in-depth knowledge of pharmacy operations, billing practices, and regulatory requirements
• Strong leadership and mentoring skills, with the ability to inspire and develop team members

Nice To Haves

• Degree in Healthcare Administration, Business, Data Analytics, or a related field
• 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

Responsibilities

• Leading complex pharmacy claim audits
• Ensuring compliance with client-specific requirements
• Delivering advanced data analysis to identify trends, risks, and opportunities for improvement
• 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 (including HIPAA)
• Providing guidance to clients and internal teams
• Focusing on continuous improvement, innovation, and strategic initiatives

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree