[Remote] Healthcare Claims Analytics Senior Consultant
Note: The job is a remote job and is open to candidates in USA. Guidehouse is seeking a Healthcare Claims Analytics Senior Consultant to support healthcare claims analysis, audits, and payment policy initiatives. The role involves analyzing claims data, identifying improper payment and fraud risks, developing dashboards and reports, translating findings into business requirements, and collaborating with stakeholders on project delivery.
Responsibilities
- 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
Skills
- 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)
- 4+ years of experience in claims processing, medical coding, auditing, or healthcare operations
- Familiarity with reimbursement methodologies, provider contracts, and claims resolution practices
- Experience with Power BI, Tableau, or similar tools for advanced data visualization
- Strong written and oral communication skills
- Ability to manage tasks independently and contribute to project execution
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
- A flexible benefits package
Company Overview