Senior Consultant – Healthcare Claims Analytics

Guidehouse

Consultant with experience in healthcare claims data analysis and auditing. Supporting claims analyses and audits to reduce improper payments and inform payment policy strategies.

Posted 6/12/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $98,000 - $163,000 per yearWebsite

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Hard Skills

SQLPythonRdata visualizationdata analysisclaims processingclaims validationauditinganomaly detectiondashboard development

Soft Skills

attention to detailcollaborationcommunicationproblem-solvingresearchdocumentationproject managementanalytical thinkingstakeholder engagementbusiness requirement interpretation

Certifications & Qualifications

Bachelor's degreePublic Trust Clearance

Industry Keywords

healthcare claims dataMedicareMedicaidVAcommercial payerhealthcare reimbursementpayment policycost-saving strategieshealthcare reformcoding rules

Tech Stack

Tools & technologies

PythonSQL

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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