Healthcare Claims Analytics Senior Consultant
About The Position
We are seeking Consultants with foundational experience in healthcare claims data, including exposure to validating, loading, processing, and analyzing claims across various payer types (e.g., Medicare, Medicaid, VA, Commercial). This role supports the development and execution of claims analyses and audits aimed at reducing improper payments, identifying potential fraud, and uncovering patterns that inform payment policy and cost-saving strategies. Demonstrate working knowledge of claims datasets and healthcare reimbursement concepts. Assist in gathering and interpreting business and technical requirements for claims audits and post-payment analysis. Conduct data-driven and qualitative research to support payment policy evaluation and anomaly detection. Build dashboards and reports using coding tools to visualize claims trends and audit findings. Research and summarize industry-standard coding rules and contribute to reimbursement policy discussions. Document findings and support the development of recommendations and follow-up actions. Contribute to analytics that identify payment trends, errors, and improper payment risks. Stay informed on state healthcare reform efforts and emerging policy changes. Translate research and claims review insights into business requirements for analytics tools. Respond to inquiries and disputes related to claims edits and policy interpretation. Collaborate with internal teams and external stakeholders to support project delivery. Support project management activities and contribute to client interactions.
Requirements
- Bachelor’s degree from an accredited university.
- At least 3+ years of professional experience, including 1+ year working with datasets to derive insights and solve problems and 1+ year of experience collaborating with internal or external stakeholders.
- Technical coding proficiency (e.g., SQL, Python, R) and experience developing basic dashboards and data visualizations.
- Exposure to healthcare data analytics and claims data.
- Strong attention to detail and ability to prepare high-quality deliverables.
- Interest in state health agencies, Medicare/Medicaid, VA, and healthcare reform.
- Ability to obtain a Public Trust Clearance (US citizenship required)
Nice To Haves
- 4+ years of experience in claims processing, medical coding, auditing, or healthcare operations.
- Familiarity with reimbursement methodologies, provider contracts, and claims resolution practices.
- Experience with Power BI, Tableau, or similar tools for advanced data visualization.
- Strong written and oral communication skills.
- Ability to manage tasks independently and contribute to project execution.
Responsibilities
- Assist in gathering and interpreting business and technical requirements for claims audits and post-payment analysis.
- Conduct data-driven and qualitative research to support payment policy evaluation and anomaly detection.
- Build dashboards and reports using coding tools to visualize claims trends and audit findings.
- Research and summarize industry-standard coding rules and contribute to reimbursement policy discussions.
- Document findings and support the development of recommendations and follow-up actions.
- Contribute to analytics that identify payment trends, errors, and improper payment risks.
- Stay informed on state healthcare reform efforts and emerging policy changes.
- Translate research and claims review insights into business requirements for analytics tools.
- Respond to inquiries and disputes related to claims edits and policy interpretation.
- Collaborate with internal teams and external stakeholders to support project delivery.
- Support project management activities and contribute to client interactions.
Benefits
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
