Healthcare Claims Analytics Consultant
Guidehouse
PythonSQL
Healthcare Claims Analytics Managing Consultant
Guidehouse
full-time
Posted on:
Location Type: Hybrid
Location: McLean • Maryland, Virginia • 🇺🇸 United States
Visit company websiteSalary
💰 $113,000 - $188,000 per year
Job Level
Mid-LevelSenior
Tech Stack
Tableau
About the role
- Serve as a strategic leader and thought partner in claims analytics, payment integrity, and reimbursement policy.
- Lead assessments of business and technical requirements for claims audits, post-payment analysis, and payment integrity strategies.
- Interpret complex healthcare data to identify anomalies, trends, and policy gaps.
- Translate insights into actionable business requirements and policy recommendations.
- Stay current on state-level healthcare transformation efforts and industry coding standards.
- Oversee development of dashboards, reports, and analytics tools to support improper payment reduction.
- Apply general coding skills to build scalable solutions and support team members in technical execution.
- Direct in-depth data modeling, scenario analysis, claims analytics, or health system performance to inform strategic decisions.
- Provide hands-on training and mentorship to junior consultants and analysts.
- Facilitate knowledge transfer, promote continuous improvement, and enhance audit readiness across teams.
- Foster a collaborative culture that encourages innovation and career growth.
- Manage complex client engagements from inception to completion, ensuring high-quality outcomes.
- Lead business development efforts, including proposal creation and relationship management.
- Support internal strategy initiatives, including offering development and community engagement.
Requirements
- Bachelor’s degree from an accredited university; advanced degree preferred (e.g., MPH, MHA, MBA, JD, or related).
- 5 to 7+ years of experience in healthcare data analytics, consulting, or claims operations, preferably with a focus on payment integrity, improper payment detection, and claims reimbursement.
- 3+ years of experience leading teams or projects involving healthcare claims data, medical coding, auditing, or post-payment analysis.
- Proven ability to translate complex data insights into strategic business requirements and policy recommendations.
- Demonstrated expertise in state health agencies, Medicare, Medicaid, VA, and healthcare reform initiatives.
- Strong financial and quantitative analysis skills, including experience in business case development, scenario modeling, and contract strategy alignment.
- Proficiency in Power BI, Tableau, and/or Alteryx, with hands-on experience developing dashboards and analytics tools.
- Excellent written and verbal communication skills, with the ability to lead client engagements, manage expectations, and present findings to diverse stakeholders.
- Experience in training and mentoring junior staff, facilitating knowledge transfer, and building team capabilities in claims analytics and payment integrity.
- 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
healthcare data analyticsclaims operationspayment integrityimproper payment detectionmedical codingauditingpost-payment analysisdata modelingscenario analysisfinancial analysis
Soft skills
leadershipmentorshipcommunicationcollaborationstrategic thinkingproblem-solvingclient engagementrelationship managementcontinuous improvementknowledge transfer
Certifications
Bachelor's degreeMPHMHAMBAJD
