Pharmacy Benefits Audits and Analytics Consultant

Segal Co.
Houston, IL
Category Operations
Remote
Job Description
Are you passionate about delivering trusted advice that improves lives? Come work with us! Our Consultant, Pharmacy Benefit Claims Audits and Analytics has responsibility for leading pharmacy benefits claims audits and analyses for our clients.

Requirements

  • Perform as the lead pharmacy claims audit consultant and/or CRM to clients.
  • Provide strategic and business-oriented consulting advice on claims auditing practices and results, serving 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.
  • Conduct technical analyses and quality reviews. Formulate conclusions and deliver client recommendations.
  • Build and maintain effective rapport internally and with senior management in client organizations, vendors, and internally within the Company.
  • Manage projects within scope, profitability and productivity targets.
  • Lead business growth strategies and marketing initiatives to assist business development and cross-selling efforts.
  • Respond to Requests For Proposals (RFPs) including preparing written proposals, providing pricing information, and defining project scope recommendations.
  • Gather, use and share market intelligence to develop and introduce unique and/or new approaches to servicing clients.
  • 6+ years of pharmacy or health claims audit and/or administration 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; experience leading efforts to achieve revenue and/or profitability-oriented objectives; actuarial experience valued.
  • Undergraduate degree. Advanced degree preferred.
  • Proficiency in Microsoft suite of products (i.e., Word, Excel, PowerPoint, and Outlook).
  • Data analysis expertise to include familiarity with SQL and Excel macros highly preferred.
  • Project management and client servicing/relationship management skills.
  • Effective interpersonal and relationship building skills with ability to build rapport with diverse audiences.
  • Proficiency in writing and oral presentation. Strong ability to problem solve, multi-task and manage multiple deadlines.
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