Job Details

Introduction

Ideal candidates will have Leadership experience in Workers' Compensation, jurisdictional knowledge and expertise preferred in California (CA), Oregon (OR), or New York (NY) (Northeast region).

• Open to all other jurisdictions.
• Remote 100%.

Leadership & Team Management

• Lead, mentor, and develop a team of claims professionals responsible for identifying, reviewing, and escalating potential internal fraud.
• Establish clear performance expectations, workflows, and quality standards to ensure accuracy, consistency, and timeliness of fraud reviews.
• Foster a culture of integrity, accountability, and continuous improvement across the team.

Claims Expertise & Quality Assurance

• Provide guidance on complex claims scenarios to ensure reviewers accurately identify red flags, anomalies, and deviations from expected handling.
• Monitor claim patterns, trends, and behaviors leveraging data, system cues, and review insights to refine detection strategies.
• Willing to develop familiarity and knowledge of claims system processes, controls, and data environment to support fraud reviews.
• Implement quality assurance checks to validate the completeness and integrity of case documentation.

Process Optimization & Controls

• Share subject matter expertise to fraud risk assessments and recommendations to enhance existing controls to reduce risk across claims operations
• Collaborate with Financial Controls, Operations, , and IT to strengthen system‑based controls, triggers, and investigative workflows.
• Develop and maintain SOPs, escalation paths, and documentation standards for all fraud review activities.

Reporting & Analytics

• Oversee timely reporting on fraud trends, case outcomes, and emerging risks to senior leadership.
• Use data to identify root causes and partner with cross‑functional teams to implement corrective actions.
• Track team metrics and KPIs to measure effectiveness and drive continuous improvement in payment review processes.

Required: Bachelor's degree; 9 years relevant claims handling experience in addition to proficiency in MS Office applications, and related claims and business software.

Previous auditing experience in addition to extensive workers compensation claims background and strong process management skills.

#LI-JA1

#REMOTE

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

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.