Healthcare Claims Analytics Senior Consultant

Guidehouse; United States; Hybride; USD 98 000 - 163 000; Plein temps

Avantages offerts par ce poste

Medical Insurance

Dental/Vision Insurance

401(k)

Parental Leave

Mobility Stipend

Holiday & Sick Time

Bonus Eligible

Education & Training

Employee Referral Program

Disability Insurance

Résumé du poste

Guidehouse seeks Consultants with healthcare claims data experience to validate, load, process, and analyze claims across Medicare, Medicaid, VA and Commercial payers. You will build dashboards, translate requirements into analytics tools, and support post-payment analyses to reduce improper payments and identify policy gaps.

Role includes collaboration with internal and external stakeholders, preparation of deliverables, and contributing to project delivery.

Qualifications

• Bachelor’s degree; 3+ years of professional experience; 1+ year deriving insights from datasets; 1+ year collaborating with stakeholders.
• Experience with healthcare data analytics and claims data.
• Proficiency in SQL, Python or R for data manipulation and analysis.

Responsabilités

• Analyze healthcare claims data across payer types to identify improper payments and fraud risks.
• Develop dashboards and reports to visualize claims trends and audit findings.
• Gather and interpret business and technical requirements for claims audits and post-pay analyses.
• Support client interactions and project delivery with data-driven recommendations.

Connaissances

SQL

Python

R

Formation

Bachelor’s degree

Outils

Power BI

Tableau

Description du poste

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.

Salary and Compensation

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

Equal Opportunity Employment

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.

About Guidehouse

Guidehouse is a global AI‑led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future.