Healthcare Claims Analytics Senior Consultant
Guidehouse · Remote · United States · 1d ago
Job Family:
Management Consulting
Travel Required:
Clearance Required:
What You Will Do:
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.
What You Will Need:
- Bachelor’s degree.
- 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.
What Would Be Nice To Have:
- 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.
- While this role is available remotely, strong preference will be given to candidates local to the DMV area who are willing and able to work onsite 2-3 days/week in our Tysons office.
The annual salary range for this position is $98,000.00-$163,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
What We Offer:
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
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
About Guidehouse
Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
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