Healthcare Claims Analytics Senior Consultant

Travel Required: Up to 25%. Ability to obtain Public Trust clearance (US citizenship required).

What You Will Do

• Support 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

• 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.

Preferred Qualifications

• 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.

Pay

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.

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

About Guidehouse

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.