Senior Consultant – Healthcare Claims Analytics

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $98k - $163k / year

⏰ Full Time

🟠 Senior

💼 Consultant

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Guidehouse

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2018

💰 Grant on 2023-02

Consulting • Digital Services • Public Sector

Guidehouse is a global consultancy offering advisory, digital, and managed services across commercial and public sectors. It is purpose-built to support industries such as national security, financial services, healthcare, energy, and infrastructure. Guidehouse collaborates with leaders to navigate complexity and drives transformational changes that impact the future. Their expertise spans data analytics, digital technologies, risk management, and more, with a strong emphasis on sustainability and innovation.

📋 Description

• 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)

🏖️ 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