Pharmacy Benefit Auditors - Come join our team and deliver trusted advice that improves lives.
- Conduct and manage pharmacy benefits claims audit projects within scope, profitability and productivity targets serving as a Consultant and/or CRM on select clients.
- Support business growth strategies and marketing initiatives in business development and cross-selling efforts. Contribute to the innovative and continual development of resources, efficiencies and quality.
- Utilize market intelligence to develop and introduce unique and/or new approaches to servicing clients.
- Provide strategic and business-oriented consulting advice on claims auditing practices and results, serve as counsel to clients and internal staff.
- Conduct planning meetings to identify/define client needs/issues and develop project plans and approaches that are responsive to client needs.
- Respond to Requests For Proposals (RFPs) including preparing written proposals, providing pricing information, and defining project scope recommendations.
- 6+ years of pharmacy benefit claims administration and/or audit experience to include significant exposure to tools relevant to an independent/third-party audit process.
- Previous Claims Auditing, Medical Coding, and/or Claims Processing experience preferred.
- Knowledge and familiarity with SQL with knowledge of Microsoft suite of products including Word, Excel, PowerPoint, and Outlook.
- Undergraduate degree. Advanced degree preferred.
- Demonstrated project management and client servicing/relationship management skills. Demonstrated experience setting and leading efforts to achieve revenue and/or profitability- oriented objectives with desired results.
- Effective interpersonal and relationship building skills with ability to build rapport with diverse audiences. High proficiency in writing and oral presentation. Ability to problem solve, multi-task and manage multiple deadlines.
Diversity and Inclusion at Segal:
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.