Manager, Claims Analytics

About the role

We are seeking a Manager, Claims Analytics to lead analytic workstreams that help health plans better understand their claims data, uncover cost and utilization trends, improve reimbursement accuracy, and enhance overall operational performance. This individual will manage project delivery, mentor team members, and develop analytic solutions that generate meaningful insights for payer and provider clients. This role requires strong experience working with healthcare claims data, technical and analytical expertise, and the ability to translate complex findings into clear, actionable recommendations for stakeholders.

Responsibilities

• Lead day-to-day delivery of claims analysis projects for multiple payer and provider clients
• Design analytic approaches that evaluate utilization, cost drivers, reimbursement patterns, and operational opportunities
• Develop advanced SQL queries, data models, and automated workflows to create scalable analytic solutions
• Guide managers and consultants in working with complex datasets including medical, pharmacy, eligibility, provider, and pricing files
• Validate data accuracy, ensure consistency across multiple data sources, and maintain rigorous quality checks
• Build dashboards and reporting frameworks using BI tools to support client decision making
• Translate large volumes of claims data into clear, compelling insights tailored to executive-level stakeholders
• Manage project plans, timelines, and prioritization across concurrent engagements
• Partner with clients to understand goals, develop custom analyses, and make strategic recommendations
• Support business development through proposals, scoping discussions, and client presentations
• Contribute to internal best practices, methodologies, and analytics frameworks
• Other duties as assigned

Requirements

• 7+ years of experience in claims analytics, healthcare data analytics, actuarial analysis, or payer/provider operations with a Bachelor’s Degree, or 11+ years of equivalent experience
• Demonstrated experience leading project teams or mentoring analysts and consultants
• Strong experience analyzing healthcare claims datasets, including medical and pharmacy
• Understanding of reimbursement methodologies across Medicare, Medicaid, Commercial, and other lines of business
• Proficiency in SQL or similar query languages used to analyze complex datasets
• Ability to identify trends, anomalies, utilization patterns, and cost drivers within claims data
• Working knowledge of healthcare coding and reimbursement structures including CPT, HCPCS, ICD, DRG, APC, and fee schedules
• Experience with BI tools such as Power BI, Tableau, or Qlik
• Strong communication skills with ability to explain analytic findings clearly
• Advanced proficiency in Excel or equivalent data tools
• Knowledge of payer operations, provider contracting concepts, and healthcare financial analysis
• Willingness to engage in direct client interaction, including travel to client locations
• Must be legally authorized to work in the United States without the need for employer sponsorship

Preferred Qualifications

• Experience supporting practice growth, solution development, or analytics capability expansion
• Experience designing automated analytic workflows or ETL processes
• Experience with SQL Server, SSIS, Python, Snowflake, or similar data environments
• Familiarity with data warehousing concepts and healthcare data architecture
• Experience building visual analytics dashboards for ongoing monitoring and reporting
• Based in Chicago, IL, and flexible to work from our Chicago office as needed

Benefits

• Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays
• Own Your Day flexible work policy
• Competitive majority employer-paid benefits: Medical, Dental, Vision, 401k Match
• Generous paid parental leave options
• Employer-paid Life Insurance, Short Term Disability, Long Term Disability
• Charitable contribution matching program
• New client commission opportunities and referral bonus program
• Bike share discount program

Pay

The estimated base salary range for this position is $145,000 - $170,000. In addition to this base salary, individuals may be eligible for an annual discretionary bonus. This range is a part of a competitive, total compensation package together with our majority employer-paid benefits and incentive pay for eligible roles.