Claims Data Strategy Lead

SmartLight Analytics

Claims Data Strategy Lead providing senior leadership in healthcare claims data initiatives. Responsible for driving solutions and delivering outcomes independently with minimal oversight.

Posted 6/23/2026full-timeRemote • 🇺🇸 United StatesSeniorWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Own and drive end‑to‑end solutions across healthcare claims data initiatives, from problem definition through implementation and validation.
Serve as a senior authority on medical, pharmacy, behavioral health, dental, DME, and ancillary claims data.
Design, build, and optimize advanced SQL‑based data models, views, and automation frameworks with a focus on performance, scalability, and maintainability.
Develop and maintain complex claim adjustment sequencing and disposition logic, including support for split claims and multiple, disparate source configurations.
Build utilization metrics tied directly to underlying service‑level data, including inpatient, outpatient, professional, and behavioral health levels of care.
Apply deep expertise in healthcare transactions and standards, including 837, 834, 820, HL7, and CCDA, to ensure data accuracy and analytical integrity.
Proactively identify data gaps, risks, and improvement opportunities and drive them to resolution without waiting for direction.
Partner closely with product, analytics, engineering, and leadership teams to ensure claims data assets support broader business and client goals.

Requirements

What you’ll need

Bachelor’s degree in Computer Science, Information Systems, or related field (or equivalent practical experience)
7-10 years of experience working with healthcare data, with deep specialization in claims data and analytics
Expert‑level proficiency in SQL and advanced query development across large, complex datasets
Extensive experience building and optimizing complex data models, views, and automation frameworks within SQL platforms
Strong understanding of healthcare claims data structures, including medical, pharmacy, behavioral health, and ancillary claims
Demonstrated ability to develop and maintain complex claim adjustment sequencing and disposition logic
Proven ability to independently assess unfamiliar data environments and rapidly develop working solutions
Strong analytical, problem‑solving, and critical‑thinking skills
Excellent communication and collaboration abilities across technical and non‑technical stakeholders
Ability to work independently, take full ownership of initiatives, and manage multiple priorities with minimal oversight.

Benefits

Comp & perks

Health insurance
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

SQLdata modelsautomation frameworksquery developmentdata analysisclaim adjustment sequencingdisposition logicutilization metricsdata validationdata optimization

Soft Skills

analytical skillsproblem-solvingcritical thinkingcommunicationcollaborationindependenceownershiptime managementleadershipstakeholder engagement

Certifications

Bachelor’s degree in Computer ScienceBachelor’s degree in Information Systems