Medical Audit Lead

Company:

Mercer

Description:

Medical Audit Lead

Role Summary

We are seeking a Medical Audit Lead to lead complex medical claims audits from planning through final reporting. This role requires deep expertise in the medical claims payment process, including how claims are billed, processed, adjudicated, and paid. The ideal candidate understands the full structure of a medical claim, can independently identify issues through detailed claim review, and can confidently evaluate and challenge vendor responses when findings are disputed.

This is a highly visible, client-facing role that also requires strong project management skills, the ability to manage multiple priorities, and excellent written and verbal communication. This is a fully remote role.

Key Responsibilities

• Lead complex medical claims audits from intake and planning through reporting and client presentation.

• Interpret plan documents, benefit provisions, exclusions, pricing methodologies, and administrative terms.

• Review and assess medical claims for accuracy, including manual identification of processing and payment issues.

• Apply strong knowledge of medical claims adjudication, billing, coding, pricing, edits, and member cost share.

• Use audit analytics tools and claim-level review to identify trends, exceptions, and potential errors.

• Develop clear, well-supported findings and prepare evidence-based responses to vendor disagreements.

• Serve as a primary client contact and communicate audit progress, issues, and results clearly and professionally.

• Manage multiple audits and deadlines while maintaining high quality and attention to detail.

Required Qualifications

• 5+ years of experience in medical claims auditing, medical claims operations, benefits administration, and/or carrier/TPA environments.

• Deep working knowledge of the medical claims payment process.

• Strong understanding of the core components of a medical claim and the ability to identify issues through manual review.

• Demonstrated ability to assess claim accuracy and support defensible audit conclusions.

• Experience evaluating and rebutting vendor or carrier responses.

• Strong project management and organizational skills.

• Excellent client-facing, written, and verbal communication skills.

• Bachelor’s degree in healthcare, business, finance, analytics, or a related field, or equivalent experience.

Preferred Qualifications

• Experience leading complex audits or large-scale claim review projects.

• Experience using audit analytics platforms or SaaS-based audit tools.

• Strong Microsoft Office skills.

Marsh (NYSE: MRSH) is a global leader in risk, reinsurance and capital, people and investments, and management consulting, advising clients in 130 countries. With annual revenue of over $27 billion and more than 95,000 colleagues, Marsh helps build the confidence to thrive through the power of perspective. For more information, visit marsh.com, or follow us on LinkedIn and X.

Marsh 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, disability, ethnic origin, family duties, gender orientation or expression, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, veteran status (including protected veterans), or any other characteristic protected by applicable law. If you have a need that requires accommodation, please let us know by contacting reasonableaccommodations@marsh.com.

The applicable base salary range for this role is $79,000 to $158,500.

The base pay offered will be determined on factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives.

We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings and other retirement programs as well as employee assistance programs.

Applications will be accepted until:

October 1, 2026