Senior Health Plan Services Consultant

Introduction

Discover a world of endless possibilities at Gallagher Benefit Services, where you'll have the power to shape the future of workplaces across industries. As a member of our team, you become the driving force behind positive change, helping clients build environments where employees thrive. Embrace the opportunity to impact lives, unlock potential, and create a legacy of remarkable transformation.

We believe that every candidate brings something special to the table, including you! So, even if you feel that you're close but not an exact match, we encourage you to apply.

Overview

BluePeak Advisors, a division of Gallagher Benefit Services, Inc., leads the nation in healthcare compliance consulting that focuses on government programs including Medicare Parts C and D, Medicaid, and Exchanges. We assist health plans, pharmacy benefit management (PBM) companies allied health companies and pharmaceutical manufacturers with regulatory, operational and compliance issues.

How you'll make an impact

The Senior Consultant Part D is a subject matter expert on the BluePeak Pharmacy Consulting team. This position provides ongoing client consulting, audit subject matter expertise and technical support for Medicare and other government sponsored health plans and vendors.

• Subject matter expertise in an operational function of Medicare Part D such as Formulary Administration and/or Coverage Determinations, Appeals and Grievances.
  Ability to review, interpret and implement state and federal guidance
  Ability to review claims and claims logic, identify and remediate issues and potential issues.
  Familiarity with CMS Program Audit process in Formulary Administration and Coverage Determinations, Appeals and Grievances.
  Monitor the implementation of pharmacy related corrective action plans and ensures that the results of the action plans are compliant.
  Mentor and drive work product based on the project management lifecycle.
  Oversee and administer ongoing monitoring program(s) based on guidance.
  Develop and update policies, procedures and Auditing and Monitoring Work Plan as needed.
  Communicate with client(s) and manage requests and expectations while providing exceptional client service.
  Perform other duties, as necessary, to meet corporate objectives.
  Performs audits and other consulting engagements.
  Travel as required

About You

Required:
Bachelor's degree and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.) Pharmacist preferred
Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
Experience with Medicare and/or Medicaid standards required
Advanced degree or certification in audit, pharmacy or compliance discipline preferred
Must have strong verbal and written communication skills.
Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.
Consulting experience preferred.

Compensation and benefits

On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.

Below are the minimum core benefits you'll get, depending on your job level these benefits may improve:

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave

Other benefits include:

• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...

We value inclusion and diversity

Click Here to review our U.S. Eligibility Requirements and Pay Disclosure Statement

Inclusion and diversity (I&D) is a core part of our business, and it's embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees' diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as "protected characteristics") by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.