Lead Specialist

Company MercerDescription We are seeking a talented individual to join our Health Operations team at Mercer This role will be based in Noida This is a hybrid role that has a requirement of working at least three days a week in the office Lead Specialist Manager US Health Benefits Claims AuditWhat can you expectWe are seeking an experienced medical Claims Auditor to join our Medical Claims team in the Specialty practice of our US Health business The ideal candidate will be responsible for auditing medical claims from health insurance carrier claims files interpreting carrier contracts and policies and engaging with carrier audit teams to resolve discrepancies and ensure proper handling of claims As an employee of Mercer the ideal candidate will adhere to company policies and performance standards and perform job duties as stipulated This individual will contribute to the teams achievement of Service Level Agreements SLAs and Key Performance Indicators KPIs We will count on you to Ensure client-specific medical carrier claim files are processed meticulously and all aberrations identified Review plan benefit details i e SPD SMM carrier plan materials ASO agreement for each audit noting unique provisions potential issues prior to audit review Analyze claims data using analytical tools including audit software and Excel and identify billing patterns and trends Interpret coding and results of system-processed medical claims Interpret and apply pertinent sections of carrier contracts and carrier policies to ensure proper claims handling Request supporting documentation and elicit carriers response to identified issues when necessary Address audit findings and any identified inconsistencies with the carriers audit team Evaluate carriers response s and processing policies and provide a rebuttal when necessary Escalate any challenges and or concerns related to audit for immediate assistance and resolution to the lead audit consultant as applicable Complete in-depth audit review of selected sample claims i e adherence to employee benefit design rates member s and plans financial responsibility billing payment and NCCI edits etc Document findings accurately on designated work papers and or audit software Complete all audit assignments within the stipulated time frame Maintain up-to-date knowledge of best practices related to health benefit claims and industry regulations Note Applicants should be flexible working in shiftsWhat you need to have Graduate with minimum 5-8 years experience overall A strong understanding of how healthcare works in the United States Experience interacting with carriers vendors and their claims processes and policies Critical thinking particularly when interpreting contracts and policies Discretionary judgement in assessing grey-area situations and escalating issues effectively A strong sense of accountability A solution-oriented mindset Intermediate to advanced level knowledge in MS Excel Must Strong oral written communication skills Capability to pivot from audit to audit and adapt to multiple processing systems Ability to work during carrier-defined system availability What makes you stand out Deep knowledge of medical claims specifically in the United States Demonstrating an inherent preference for acting in a meticulous and diligent manner Communication that is structured crisp and clear Exceptional judgement and clear rationales in decision-making Ability to prioritize time effectively across competing priorities Adaptable communicator facilitator and problem solver High attention to detail Good relationship skills Proven ability to work on own initiative as well as in a team Why join our team We help you be your best through professional development opportunities interesting work and supportive leaders We foster a vibrant and inclusive culture where you can work with talented colleagues to create new solutions and have impact for colleagues clients and communities Our scale enables us to provide a range of career opportunities as well as benefits and rewards to enhance your well-being NYSE MMC is a global leader in risk strategy and people advising clients in 130 countries across four businesses and With annual revenue of 23 billion and more than 85 000 colleagues Marsh McLennan helps build the confidence to thrive through the power of perspective For more information visit or follow on and Marsh McLennan is committed to embracing a diverse inclusive and flexible work environment We aim to attract and retain the best people and embrace diversity of age background caste disability ethnic origin family duties gender orientation or expression gender reassignment marital status nationality parental status personal or social status political affiliation race religion and beliefs sex gender sexual orientation or expression skin color or any other characteristic protected by applicable law Marsh McLennan is committed to hybrid work which includes the flexibility of working remotely and the collaboration connections and professional development benefits of working together in the office All Marsh McLennan colleagues are expected to be in their local office or working onsite with clients at least three days per week Office-based teams will identify at least one anchor day per week on which their full team will be together in person Mercer a business of Marsh McLennan NYSE MMC is a global leader in helping clients realize their investment objectives shape the future of work and enhance health and retirement outcomes for their people Marsh McLennan is a global leader in risk strategy and people advising clients in 130 countries across four businesses Marsh Guy Carpenter Mercer and Oliver Wyman With annual revenue of 24 billion and more than 90 000 colleagues Marsh McLennan helps build the confidence to thrive through the power of perspective For more information visit mercer com or follow on LinkedIn and X Marsh McLennan is committed to embracing a diverse inclusive and flexible work environment We aim to attract and retain the best people and embrace diversity of age background caste disability ethnic origin family duties gender orientation or expression gender reassignment marital status nationality parental status personal or social status political affiliation race religion and beliefs sex gender sexual orientation or expression skin color or any other characteristic protected by applicable law Marsh McLennan is committed to hybrid work which includes the flexibility of working remotely and the collaboration connections and professional development benefits of working together in the office All Marsh McLennan colleagues are expected to be in their local office or working onsite with clients at least three days per week Office-based teams will identify at least one anchor day per week on which their full team will be together in person