Healthcare Claims Analytics Managing Consultant
Guidehouse
Tableau
Healthcare Claims Analytics Consultant
Guidehouse
full-time
Posted on:
Location Type: Hybrid
Location: McLean • Maryland, Virginia • 🇺🇸 United States
Visit company websiteSalary
💰 $74,000 - $124,000 per year
Job Level
JuniorMid-Level
Tech Stack
PythonSQL
About the role
- 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 2+ 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
SQLPythonRdata visualizationdata analysisclaims processingclaims validationanomaly detectiondashboard developmentdata-driven research
Soft skills
attention to detailcollaborationcommunicationproblem-solvinganalytical thinkingorganizational skillsclient interactiondocumentationrecommendation developmentproject management
Certifications
Bachelor's degreePublic Trust Clearance
