Manager, Medical Audit Services

At Lockton, we’re passionate about helping our people achieve their ultimate potential. Our people are curious, action-oriented and always striving to make ourselves and those around us better. We’re active listeners working to ensure understanding and problem solvers developing innovative solutions. If you can see yourself delivering excellent service to clients, giving back to our communities and being a part of our caring culture, you belong here. Responsible for internal reference documents for Consultants and Health & Welfare teams, leading training sessions to educate new hire colleagues on medical audit offerings Create and maintain audit templates such as audit notification letters, documentation request lists, report templates, sample workbooks, etc. Responsible for performing and supporting complex audits of medical plans including but not limited to retrospective claims, operational, pre & post-implementation audits across all lines of business (Commercial, Medicare, Medicaid, Exchange, DSNP, EGWP) Lead others in completing audits of medical plans Serve as a subject matter expert in claim payment and compliance relative to client contracts, regulatory requirements and vendor health programs Utilize results of initial claim data evaluations to select focused audit samples for review and response by the carrier; attend on-site audit to review claims and backup detail as necessary to determine accuracy of claim processing and payment Work with carriers to determine root cause of errors, determine impact, and report audit results to clients of varying size and type (employers, health plans, etc) Assist Consultants with discovery calls to explore potential clients’ interest in completing audits and developing solutions that meet their unique needs Develop a tool to track audit status and results, developing key performance indicators and audit statistics/insights Other responsibilities as deemed necessary to support the business

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Qualifications College degree (experience may be considered in lieu of college degree) 7+ years’ experience in medical claims auditing or consulting Must demonstrate a high level of medical claims and health benefit administration knowledge under various lines of business (Commercial, Medicare, Medicaid) Exceptional oral and written communication skills with high attention to detail Ability to deliver results per an agreed upon timeline while keeping all stakeholders informed Self-directed with strong project management skills Ability to adjust to changing priorities without losing momentum toward overarching goals Comfortable working collaboratively with others at all levels of an organization Strong people leader with the ability to identify others’ motivators and potential for growth Intermediate or expert level experience with Microsoft Suite (Word, Excel, PowerPoint) Ability to travel as required for audits Preferred Qualifications & Attributes Experience with SQL and/or Alteryx Advanced degree in healthcare analytics or similar field Experience in medical billing or coding Equal Opportunity Statement Lockton Companies is proud to provide everyone an equal opportunity to grow and advance. We are committed to an inclusive culture and environment where our people, clients and communities are treated with respect and dignity. At Lockton, supporting diversity, equity and inclusion is ingrained in our values, and we believe that we are at our best when we fully embrace everyone. We strive to cultivate a caring culture that learns from, celebrates and thrives because of our breadth of differences. As such, we recognize that recruiting, developing and retaining people with diverse backgrounds and experiences is vital and enabling our people to thrive personally and professionally is critical to our long‑term success. About Lockton Lockton is the largest privately held independent insurance brokerage in the world. Since 1966, our independence has allowed us to serve our clients, take care of our people and give back to our communities. As such, our 13,100+ Associates doing business in over 155 countries are empowered to do what’s right every day. At Lockton, we believe in the power of all people. You belong at Lockton. How We Will Support You At Lockton, we empower you to be true to yourself in all that you do. Your success is our success, and we provide opportunities to help you grow and create a rewarding career path, however you envision it. We are ready to meet you where you are today, and as your needs change over time. In addition to industry‑leading health insurance, we offer additional options to support your overall health and wellbeing. #J-18808-Ljbffr Lockton Companies