Healthcare Claims Analytics Consultant

Job Family :

Management Consulting

Travel Required : Up to 25%

Clearance Required :

Ability to Obtain Public Trust

What You Will Do :

We are seekingConsultantswith foundational experience inhealthcare claims data including exposure to validating loading processing and analyzing claims across various payer types (). This role supports the development and execution ofclaims analyses and auditsaimed at reducing improper payments identifying potential fraud and uncovering patterns that inform payment policy and cost-saving strategies.

• Demonstrate working knowledge ofclaims datasetsandhealthcare reimbursementconcepts.
• Assist in gathering and interpretingbusiness and technical requirementsfor claims audits and post-payment analysis.
• Conductdata-driven and qualitative researchto support payment policy evaluation and anomaly detection.
• Builddashboards and reportsusing coding tools to visualize claims trends and audit findings.
• Research and summarizeindustry-standard coding rulesand contribute to reimbursement policy discussions.
• Document findings and support the development ofrecommendations and follow-up actions.
• Contribute to analytics that identifypayment trendserrors andimproper payment risks.
• Stay informed onstate healthcare reform effortsand emerging policy changes.
• Translate research and claims review insights intobusiness requirementsfor analytics tools.
• Respond to inquiries and disputes related toclaims editsandpolicy 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 :

What Would Be Nice To Have :

The annual salary range for this position is $74000.00-$124000.00. 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 EmployerProtected 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- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Required Experience :

Contract

Key Skills

Civil,Apparel,Banking,CMS,Infection Control

Employment Type : Full-Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 74000 - 124000