Healthcare Claims Analytics Senior Consultant

Guidehouse; Arlington (VA); On-site; USD 98,000 - 163,000; Full time

Benefits offered by this job

Medical Insurance

Mobility Stipend

401(k) Plan

Parental Leave

Job summary

Guidehouse is seeking Consultants with foundational healthcare claims data experience to validate, load, process, and analyze claims from Medicare, Medicaid, VA, and Commercial payers. You will help develop claims analyses and audits to reduce improper payments, identify potential fraud, and uncover patterns that inform policy and cost-saving strategies.

You will build dashboards and reports, translate insights into business requirements for analytics tools, and collaborate with internal and

Qualifications

• Bachelor's degree required.
• 3+ years of professional experience with datasets to derive insights and solve problems.
• Proficiency in SQL, Python, or R and experience building dashboards and data visualizations.
• Exposure to healthcare data analytics and claims data.

Responsibilities

• Demonstrate working knowledge of claims datasets and 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.

Skills

SQL

Python

R

Dashboards

Data analytics

Attention to detail

Education

Bachelor's degree

Tools

Power BI

Tableau

Job description

What You Will Do

We are seeking Consultants with foundational experience in healthcare claims data, including exposure to validating, loading, processing, and analyzing claims across various payer types (e.g., Medicare, Medicaid, VA, Commercial). This role supports 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.

Job Family

Management Consulting

Travel Required

Up to 25%

Clearance Required

Ability to Obtain Public Trust

What You Will Do

We are seeking Consultants with foundational experience in healthcare claims data, including exposure to validating, loading, processing, and analyzing claims across various payer types (e.g., Medicare, Medicaid, VA, Commercial). This role supports 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.

What You Will Need

• Bachelor's degree.
• 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.
• Ability to obtain a Public Trust Clearance.

What Would Be Nice To Have

• 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.
• While this role is available remotely, strong preference will be given to candidates local to the DMV area who are willing and able to work onsite 2-3 days/week in our Tysons office.

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.

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 Employer–Protected 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 1-571-633-1711 or via email at [e-mail]. 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 @guidehouse.com or [e-mail]. 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 Guidehouse's Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [e-mail]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s 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.