Healthcare Claims Analytics Managing Consultant

Management Consulting Role

We are seeking experienced managers with subject matter expertise in healthcare claims data, including knowledge of validating, loading, processing, and analyzing healthcare claims data, preferably a variety of claims (Medicare, Medicaid, VA, Commercial). The role will lead strategy, analytics, and audit initiatives aimed at enhancing payment integrity programs, reducing improper payments, identifying fraud and anomalies, and determining payment trends that inform policy and drive cost savings. The successful candidate will:

• Serve as a strategic leader and thought partner in claims analytics, payment integrity, and reimbursement policy.
• Lead assessments of business and technical requirements for claims audits, post-payment analysis, and payment integrity strategies.
• Interpret complex healthcare data to identify anomalies, trends, and policy gaps.
• Translate insights into actionable business requirements and policy recommendations.
• Stay current on state-level healthcare transformation efforts and industry coding standards.
• Oversee development of dashboards, reports, and analytics tools to support improper payment reduction.
• Apply general coding skills to build scalable solutions and support team members in technical execution.
• Direct in-depth data modeling, scenario analysis, claims analytics, or health system performance to inform strategic decisions.
• Provide hands-on training and mentorship to junior consultants and analysts.
• Facilitate knowledge transfer, promote continuous improvement, and enhance audit readiness across teams.
• Foster a collaborative culture that encourages innovation and career growth.
• Manage complex client engagements from inception to completion, ensuring high-quality outcomes.
• Lead business development efforts, including proposal creation and relationship management.
• Support internal strategy initiatives, including offering development and community engagement.

What You Will Need:

• Bachelor's degree from an accredited university; advanced degree preferred (e.g., MPH, MHA, MBA, JD, or related).
• 5+ years of experience in healthcare data analytics, consulting, or claims operations, preferably with a focus on payment integrity, improper payment detection, and claims reimbursement.
• 3+ years of experience leading teams or projects involving healthcare claims data, medical coding, auditing, or post-payment analysis.
• Proven ability to translate complex data insights into strategic business requirements and policy recommendations.
• Demonstrated expertise in state health agencies, Medicare, Medicaid, VA, and healthcare reform initiatives.
• Strong financial and quantitative analysis skills, including experience in business case development, scenario modeling, and contract strategy alignment.
• Proficiency in Power BI, Tableau, and/or Alteryx, with hands-on experience developing dashboards and analytics tools.
• Excellent written and verbal communication skills, with the ability to lead client engagements, manage expectations, and present findings to diverse stakeholders.
• Experience in training and mentoring junior staff, facilitating knowledge transfer, and building team capabilities in claims analytics and payment integrity.
• Ability to obtain a Public Trust clearance (US Citizenship required)

What Would Be Nice To Have:

• Master's or advanced degree in Public Health, Health Administration, Business, Law, Data Science, or a related field.
• Deep understanding of reimbursement methodologies, provider contract structures, and claims processing workflows, including resolution practices and audit strategies.
• Experience applying advanced data analytics to healthcare claims, including anomaly detection, trend analysis, and improper payment identification.
• Demonstrated strategic problem-solving ability, with experience managing discrete projects, initiatives, and cross-functional teams.
• Strong self-management and organizational skills, with the ability to lead engagements from design through implementation.
• Track record of supporting business development, proposal writing, and relationship management in a consulting or advisory capacity.

The annual salary range for this position is $113,000.00-$188,000.00. 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.

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 EmployerProtected 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 RecruitingAccommodation@guidehouse.com.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. 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 recruiting@guidehouse.com. 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.