Lead - Claims

AArete; Pune District; On-site; INR 4,000,000 - 6,000,000; Full time

Job summary

AArete is seeking a Lead - Claims to partner with US healthcare payer clients, driving cost reductions and improved payment accuracy. You will dig into data, research payer topics, and develop actionable recommendations.

You'll work across claims, reimbursement, and operations, translating complex analyses into client-ready insights and leading cross-functional workstreams to deliver measurable outcomes.

Qualifications

• 10+ years of healthcare analytics or payer operations experience.
• Strong SQL skills and ability to analyze large datasets.
• Experience communicating findings to clients.

Responsibilities

• Research payer topics and industry trends.
• Analyze medical, eligibility, pricing, and reimbursement data to identify opportunities.
• Use SQL to evaluate utilization and cost drivers.
• Develop recommendations and cost-saving business cases.
• Create presentations and dashboards explaining analyses.
• Lead workstreams and coordinate with stakeholders.

Skills

SQL

Excel

Healthcare analytics

Data analysis

Client-facing

Research skills

Presentation skills

Problem solving

Team coordination

Education

Bachelor's degree or equivalent

Tools

Snowflake

Job description

Job Summary

Lead - Claims

The Role

As a Lead, you will work with US healthcare payer clients to identify opportunities that reduce medical and administrative costs, improve payment accuracy, and strengthen operational performance. You will help clients understand business issues, dig into the data, and develop recommendations that can be put into action. We are looking for someone who is comfortable going deep on unfamiliar payer topics, knows how to research quickly and thoughtfully, and can connect the dots across claims, operations, reimbursement, and client priorities.

Work You'll Do

• Research payer topics, industry trends, regulations, operating models, and client-specific business issues.
• Review and analyze medical, eligibility, provider, pricing, reimbursement, and other healthcare data to find trends, issues, and opportunities.
• Use SQL and other tools to work through large datasets and evaluate utilization, cost drivers, reimbursement patterns, payment accuracy, and operational performance.
• Check data quality, test assumptions, document the logic behind the analysis, and make sure the work can stand up to client review.
• Develop recommendations, business cases, and implementation plans tied to cost savings, process improvement, medical cost management, and operational efficiency.
• Build practical points of view on payer topics such as claims, provider networks, reimbursement, payment integrity, utilization management, prior authorization, medical management and payer operations.
• Take loosely defined problems and turn them into a clear workplan by identifying the right questions, data sources, research sources, and decision points.
• Create presentations, summaries, dashboards, and reports that clearly explain what the analysis shows and what actions the client should consider.
• Lead workstreams, manage day-to-day analysis, and coordinate with client stakeholders, vendors, and internal AArete teams.
• Explain technical findings in plain business language during client meetings and internal working sessions.
• Identify related client needs and bring them to leadership when additional AArete support may be useful.
• Bring sound judgment, ownership, curiosity, and a hands-on problem-solving mindset to each engagement.
• Other duties as assigned

Requirements

• 10+ years of experience in healthcare analytics, payer operations, claims analytics, healthcare operations, or a similar client-facing role.
• Bachelor's degree required, or equivalent experience.
• Strong understanding of healthcare claims data, health plan data, payer processes, provider data, reimbursement concepts, and claims data structures.
• Good SQL skills and experience working with large datasets. Experience with Snowflake, Excel, or similar tools is helpful.
• Advanced Excel with the ability to create clean, client-ready analysis.
• Strong analytical skills and the ability to move from data to insights, recommendations, and business cases.
• Excellent research skills, including the ability to learn unfamiliar payer topics, evaluate sources, pull out what matters, and explain the business implications clearly.
• Ability to contribute across a broad payer agenda, including claims, benefits, provider data, contracting, reimbursement, payment integrity, medical cost management, utilization management, prior authorization, risk adjustment, quality, Stars, member/provider experience, and operational transformation.
• Strong written and verbal communication skills, with the ability to explain complex analysis to both business and client audiences.
• Comfort working in fast-moving project environments with internal teams, clients, and vendors.
• High ownership, curiosity, accountability, and openness to feedback.

Preferred Requirements

• Direct payer experience is strongly preferred.
• Experience with claims analytics and/or network analytics, including payer/provider contracts, reimbursement language, and common contract terms.
• Exposure to medical management, utilization management, prior authorization, clinical operations.

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.