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Guidehouse
Guidehouse
H1B Visa SponsorDefenseHealthcareLogistics
Guidehouse is a global consulting firm that provides advisory, digital, and managed services to commercial and public-sector organizations. Its work supports clients in national security, financial services, healthcare, energy, and infrastructure, combining data analytics, digital technologies, risk management, and related expertise to address complex operational and strategic challenges. Guidehouse also emphasizes sustainability and innovation in its approach to organizational transformation.
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Senior Healthcare Claims Analytics Consultant

At Guidehouse, analyze healthcare payer claims, audits, and data trends to help reduce improper payments and inform payment policy. Develop dashboards and insights across Medicare, Medicaid, VA, and commercial claims.

USUnited StatesVAVirginia
$98,000 – $163,000 / year
HybridFull-timeSeniorEnglish RequiredConsultant
PythonSQLTableau

Description

  • Validate and analyze claims from Medicare, Medicaid, VA, and commercial payers.
  • Conduct claims analyses and audits to reduce improper payments and flag potential fraud.
  • Find patterns that can inform payment policy and cost-saving strategies.
  • Gather and interpret business and technical needs for claims audits and post-payment reviews.
  • Use quantitative and qualitative research to evaluate payment policies and detect anomalies.
  • Create dashboards and reports with coding tools to show claims trends and audit results.
  • Research and summarize standard industry coding rules.
  • Contribute to discussions about reimbursement policy.
  • Record findings and help shape recommendations and follow-up actions.
  • Track payment trends, errors, and risks of improper payments.
  • Follow state healthcare reform initiatives and policy developments.
  • Turn research and claims review findings into business requirements for analytics tools.
  • Address questions and disputes about claims edits and policy interpretation.
  • Work with internal teams and external stakeholders.
  • Assist with project coordination and client engagement.

Requirements

  • Bachelor’s degree.
  • At least three years of professional experience.
  • At least one year working with datasets to draw insights and solve problems.
  • At least one year collaborating with internal or external stakeholders.
  • Coding proficiency in SQL, Python, or R.
  • Experience creating basic dashboards and data visualizations.
  • Exposure to healthcare analytics and claims data.
  • Careful attention to detail and ability to produce high-quality deliverables.
  • Interest in state health agencies, Medicare and Medicaid, the VA, and healthcare reform.
  • Ability to obtain Public Trust clearance.
  • Preferred: four or more years in claims processing, medical coding, auditing, or healthcare operations.
  • Familiarity with reimbursement methods, provider contracts, and claims resolution practices.
  • Experience using Power BI, Tableau, or similar tools for advanced data visualization.
  • Strong written and verbal communication skills.
  • Ability to manage tasks independently and contribute to project delivery.
  • Candidates in the DC, Maryland, and Virginia area are preferred and should be willing and able to work onsite two to three days per week at the Tysons office.

Benefits

  • Medical, prescription, dental, and vision insurance.
  • Personal and family sick time, plus company-paid holidays.
  • May qualify for a discretionary variable incentive bonus.
  • Parental leave and adoption assistance.
  • 401(k) retirement plan.
  • Basic and supplemental life insurance.
  • Health savings account, dental and vision accounts, and dependent care flexible spending accounts.
  • Short-term and long-term disability coverage.
  • Student loan paydown program.
  • Tuition reimbursement, personal development, and learning opportunities.
  • Skills development and certifications.
  • Employee referral program.
  • Company-sponsored events and community outreach.
  • Emergency backup childcare program.
  • Mobility stipend.
  • Flexible benefits package.
  • Flexible work arrangements, with remote availability.

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