Claims Manager

BGB Group; United States; On-site; USD 100,000 - 130,000; Full time

Job summary

A healthcare consulting firm in the United States is seeking a Claims Manager to conduct complex analyses of medical and pharmacy claims. This role requires deep expertise in claims data and the ability to translate insights into strategic recommendations. The ideal candidate will have 5-8 years of relevant experience and strong skills in data analysis tools. This position offers a competitive salary and bonus eligibility, contributing to essential pitch strategies and business growth.

Qualifications

• 5–8+ years of experience with healthcare claims (medical and pharmacy), ideally in consulting or analytics.
• Experience in supporting pitches and external presentations is highly desirable.

Responsibilities

• Conduct complex analyses of medical and pharmacy claims to uncover utilization patterns.
• Validate and reconcile claims data ensuring alignment with coding standards.
• Develop deliverables such as dashboards and visualizations for insights.
• Synthesize data to support market access strategy and brand recommendations.

Skills

Claims coding systems expertise

Excel proficiency

SQL experience

R knowledge

Python programming

SAS experience

Data visualization with Tableau or Power BI

Analytical skills

Critical thinking

Problem-solving capabilities

Education

Bachelor's degree in public health or related field

Advanced degree

Job description

Position Overview

We are seeking a highly analytical and detail-oriented Claims Manager to serve as a senior, hands‑on subject matter expert in claims analysis and insights. The Claims Manager will be the most experienced executional resource on the team—responsible for conducting complex claims analyses, ensuring accuracy and quality, and elevating the use of claims insights across BGB. A key part of this role includes supporting BGB’s New Business & Growth team, delivering fast‑turn claims analyses and compelling data stories that enhance pitch strategies and differentiate BGB in competitive reviews. The ideal candidate brings deep expertise in medical and pharmacy claims data, strong problem‑solving skills, and the ability to translate data findings into clear, strategic insights for both technical and non‑technical audiences.

Key Responsibilities

• Independently conduct complex analyses of medical, pharmacy, and specialty claims to uncover utilization patterns, payer behavior, coding inconsistencies, and real‑world trends.
• Validate and reconcile claims data with a high degree of accuracy, ensuring alignment with coding standards (ICD‑10, CPT, HCPCS, NDC).
• Serve as the primary executional resource for high‑visibility claims requests, both internal and client‑facing.
• Synthesize data into clear, actionable insights that support market access strategy, payer initiatives, and brand recommendations.
• Develop polished deliverables—slide summaries, dashboards, tables, or visualizations—that communicate insights succinctly and effectively.
• Identify emerging data patterns and proactively flag opportunities or risks informed by claims signals.
• Act as the claims expert on pitches, delivering quick‑turn analyses and insight summaries that support strategy, creative, and medical storytelling.
• Collaborate with the SVP, Business Development/Growth and pitch leadership to craft claims‑driven narratives that strengthen capabilities presentations, RFP responses, and final pitches.
• Provide claims insights that help differentiate BGB’s value proposition in competitive pitch environments.
• Work closely with Strategy, Market Access, Medical Strategy, Engagement Strategy, Insights, Data Science, and Account teams to integrate claims insights into multi‑disciplinary deliverables.
• Participate in working sessions, internal reviews, and pitch rehearsals to ensure claims insights are represented accurately and strategically.
• Serve as a trusted internal consultant for claims‑related questions and methodological guidance.
• Ensure all claims outputs meet high standards of analytical rigor, accuracy, and documentation.
• Help refine analysis templates, SOPs, and best practices to support consistency and efficiency across claims work.
• Support adherence to data privacy, compliance, and proper data‑use protocols.

Preferred Qualifications

• 5–8+ years of experience working with healthcare claims (medical and pharmacy), ideally in payer, consulting, pharma, market access, or analytics environments.
• Experience supporting pitches, new business cycles, or external presentations is highly desirable.
• Strong familiarity with claims datasets (IQVIA, Komodo, DRG, Symphony, Clarivate, etc.).

Skills

• Expertise in claims coding systems (ICD‑10, CPT, HCPCS, NDC).
• High proficiency in Excel; experience with SQL, R, Python, SAS, or visualization tools (Tableau, Power BI) preferred.
• Strong analytical, critical‑thinking, and problem‑solving capabilities.
• Ability to translate complex data into clear, digestible insights.

Attributes

• Extremely detail‑oriented, organized, and reliable—especially under tight deadlines.
• Strong communicator who can explain technical concepts to non‑technical stakeholders.
• Thrives in fast‑paced, dynamic environments, particularly during pitch cycles.
• Collaborative and proactive with a solutions‑oriented mindset.

Education

• Bachelor’s degree in public health, health economics, data analytics, biostatistics, life sciences, or a related field required.
• Advanced degree is a plus.

Salary Range

$100,000 - $130,000 base salary + bonus eligibility

Equal Opportunity Employer

BGB Group is an equal opportunity employer. All applicants will be considered without regard to race, color, religion, sex, age, national origin, citizenship status, sexual orientation, disability, veteran status or any category or class of person protected by law.