Human Capital Total Rewards Health Claims Review Position Sr Consultant NYC

Deloitte & Touche USA LLP is the U.S. member firm of Deloitte Touche Tohmatsu and services are provided by its subsidiaries, including Deloitte & Touche LLP, Deloitte Consulting LLP, Deloitte Financial Advisory Services LLP and Deloitte Tax LLP. Deloitte & Touche USA LLP?s subsidiaries are among the nation?s leading professional services firms, providing audit, tax, consulting, and financial advisory services through nearly 30,000 people in more than 80 cities. Known as employers of choice for innovative human resources programs, they are dedicated to helping their clients and people excel.

Deloitte Consulting LLP is one of the world's largest and fastest growing management consulting firms.? We provide strategic, operational, and financial and technology related advisory services to many of the world's most prestigious companies.? We are business performance consultants. We are known for our straightforward approach to solving our clients' most complex business challenges. Deloitte consultants
work hand-in-hand with clients to improve business performance, drive shareholder value, and create competitive advantage in the most practical, sensible ways possible.
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Our Human Capital professionals specialize in integrating people issues with business strategy. We have the depth and breadth to assist with large-scale change in ownership and Enterprise Resource Planning (ERP) installations, as well as singular program designs and ongoing actuarial evaluations. Ultimately, our mission is to enhance our client's performance, productivity and profitability.? Our Human Capital services include:
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Deloitte's Total Rewards group addresses the business strategy, corporate culture, and global alignment of employee benefit programs. We provide design, delivery, and performance improvement solutions to purchasers, providers, and administrators of employee benefits. Our approach includes technical expertise in retirement, health care, compensation, communications, and tax.

Deloitte Consulting
LLP (Deloitte Consulting) is looking for a health care consultant to serve in a Senior Consultant or Manager role in the Total Rewards practice of Deloitte Consulting's Human Capital Advisory Services group.? In this position, the candidate will assist Deloitte Consulting Senior Managers and Principals in providing strategic and technical employee benefit consulting services to plan sponsors (e.g., employers, municipal governments, health & welfare funds, etc.).? This specific posting is for a candidate who has experience in performing high level operational assessments and claim transactional reviews of medical, prescription drug and dental claims paid by a third party administrator or health plan.
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A representative sample of a the job's primary responsibilities
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????????? Preparation for claim review and onsite activities
?????? Prepare and submit data request
?????? Conduct kick-off conference call outlining process, onsite requirements and calculation methodology
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Submit sample and documentation request
?????? Prepare customized checklist
?????? Scheduling of resources
?????? Produce mail merge and pre-populate checklist
????????? Coordinate onsite activities for operational and claim transaction reviews
?????? Coordinating with third party administrator ?(TPA) or health plan (HP)
?????? Sending operational questionnaire and reviewing responses before onsite review
?????? Clarifying any questions from questionnaire while onsite for the claims transaction review
?????? Coordinating claim reviewers for the onsite claims transaction review
?????? Performing second review of claim reviewers work while onsite
?????? Coordinating rebuttal process on suspected errors with TPA or HP
????????? Follow-up on outstanding issues from onsite operational and claims transactional review
????????? Drafting summary report and supporting documentation
????????? Client management activities
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A representative sample of a the job's
secondary responsibilities
????????? Manage/conduct competitive vendor searches and selection initiatives for various H& benefit plans
????????? Prepare client presentations and reports
????????? Work with TPA or HP on process improvement assessments and recommendations
????????? Conduct other general health & welfare consulting activities, as required
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In addition to serving plan sponsors, other project work could include working with health plan payers in such projects as operational assessments, quality program design or assessment, etc.
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Requirements of the ideal candidate
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????????? Strong understanding of health care plan design, operations and claims processing
????????? Knowledge (plan design and pricing) of other health & welfare benefit plans (e.g., life, disability, dental, etc.)
????????? Strong client presence
????????? Ability to work well in team-based environment
????????? Project management, presentation, and facilitation skills
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Well-organized with the ability to handle several projects/clients simultaneously
????????? Well-developed verbal and written communication skills
????????? Proficiency with MS Office products, including Word, Excel, PowerPoint and Access
????????? Ability to work independently and develop client relationships
????????? Strong work ethic with a commitment to client service excellence
????????? Flexibility to perform onsite reviews out of town for an extended period of time
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Education and Experience
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????????? Undergraduate degree
????????? Minimum of 5 years of experience in health care consulti

Deloitte & Touche USA LLP and its subsidiaries ("the Deloitte US Firms") are equal opportunity employers.

About Deloitte
Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms and their respective subsidiaries and affiliates. As a Swiss Verein (association), neither Deloitte Touche Tohmatsu nor any of its member firms has any
liability for each other?s acts or omissions. Each of the member firms is a separate and independent legal entity operating under the names ?Deloitte,? ?Deloitte & Touche,? ?Deloitte Touche Tohmatsu,? or other related names. Services are provided by the member firms or their subsidiaries or affiliates and not by the Deloitte Touche Tohmatsu Verein.
Deloitte & Touche USA LLP is the U.S. member firm of Deloitte Touche Tohmatsu. In the U.S., services are provided by the subsidiaries of Deloitte & Touche USA LLP (Deloitte & Touche LLP, Deloitte Consulting LLP, Deloitte Financial Advisory Services LLP, Deloitte Tax LLP and their subsidiaries), and not by Deloitte & Touche USA LLP.




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