9 days old

Senior Consultant, Medical Claims Audits - Chicago & New York

The Segal Group
Chicago, Illinois 60606
  • Job Code
  • Job Type
  • Job Status
    Full Time

About Segal:

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. 


ID = SP00000049


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 Role:

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:

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 



  • Bachelors degree
  • 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 (verbal/written) skills


Posted: 2019-10-04 Expires: 2019-11-03

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Senior Consultant, Medical Claims Audits - Chicago & New York

The Segal Group
Chicago, Illinois 60606

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