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 protected characteristics by applicable federal, state, or local laws.
Managed Care Specialist
Location
United States
Posted
65 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Managed Care Specialist
Gallagher
Introduction At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. How you'll make an impact Primary Responsibilities: - Maintain various programs, including: - Oversight of medical bill processes (eBill interfaces and bill review). - PPO/Specialty Networks. - Pharmacy processes. - Case management processes (UR/TCM/FCM, eInvoice, nurse note, and Electronic Referral). - Customer service/litigation issues. - Vendor security and other related programs. - Sustain continuous communication with managed care vendors to ensure service program expectations are identified and maintained. - Manage questions/issues from internal and external users related to: - Managed care programs (e.g., scanning, medical bill review, case management, pharmacy). - Managed care processes (e.g., eBill, eInvoice, auto referral). - Managed care interfaces. - Resolve and troubleshoot service issues through appropriate channels. Essential Duties: - Develop and enhance existing managed care workers' compensation programs. - Direct vendor activity, including: - Authorization of fee applications. - Assessing the impact on clients' funding mechanisms. - Participate in client and/or vendor meetings. - Exercise decision-making authority on: - Client fees and credits of significant value. - Allocation of fines and penalties (approve/deny as necessary). - Serve as a communications liaison between managed care vendors and servicing branches. - Demonstrate managed care expertise by independently directing vendor activities that directly impact client expenditures and company revenue. - Develop and direct client-specific initiatives, including: - Customization of claim intake, scanning, and bill review services. - Identify and implement workflows and processes to streamline operations and improve efficiencies. About You Required Qualifications: - Bachelor’s degree. - 3 years of direct insurance industry experience. - General knowledge of the workers' compensation managed care industry. - Excellent written and oral communication skills. - Strong organizational skills with the ability to: - Prioritize workload. - Manage multiple tasks simultaneously. - Ability to travel up to 20%. Preferred Qualifications: - Proficiency in computer applications, including: - risxfacs.com. - Microsoft Outlook, Excel, Word, PowerPoint, and Access. - Familiarity with Access or enterprise database programs is a plus. Behaviors: - Ability to work under pressure with minimal guidance. - Must be a team player. Compensation and benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. 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... **The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process. We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements 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.
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FOX RehabilitationFox Rehabilitation is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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