Senior Healthcare Claims Analytics Consultant

Guidehouse

. Validate, load, process, and analyze healthcare claims across Medicare, Medicaid, VA, and Commercial payer types .

Posted 10/12/2026full-timeMcLean • Virginia • United StatesSenior💰 $98,000 - $163,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare claims analysis, including validation, processing, and auditing across various payer types. Proficient in SQL, Python, or R for data analysis and visualization, with a strong focus on identifying payment trends and supporting reimbursement policy discussions.

Highest-signal resume keywords

Healthcare Claims AnalysisSQL ProficiencyData Visualization with Power BIClaims Auditing ExperienceCollaboration with Stakeholders

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisClaims ProcessingMedical CodingAuditingHealthcare Data AnalyticsDashboard DevelopmentSQLPythonRData Visualization

Soft Skills

Attention to DetailStrong Communication SkillsIndependent Task Management

Tools & Technologies

Power BITableau

Certifications & Qualifications

Public Trust Clearance

Industry Keywords

MedicareMedicaidVAHealthcare ReformReimbursement MethodologiesProvider ContractsClaims Resolution Practices

Tech Stack

Tools & technologies

PythonSQLTableau

About the role

Key responsibilities & impact

Validate, load, process, and analyze healthcare claims across Medicare, Medicaid, VA, and Commercial payer types
Develop and execute claims analyses and audits to reduce improper payments and identify potential fraud
Uncover patterns informing payment policy and cost-saving strategies
Gather and interpret business and technical requirements for claims audits and post-payment analysis
Conduct data-driven and qualitative research supporting 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
Contribute to reimbursement policy discussions
Document findings and support recommendations and follow-up actions
Identify payment trends, errors, and improper payment risks
Monitor 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
Support project management activities and client interactions

Requirements

What you’ll need

Bachelor’s degree
At least 3+ years of professional experience
At least 1 year working with datasets to derive insights and solve problems
At least 1 year of experience collaborating with internal or external stakeholders
Technical coding proficiency in SQL, Python, or R
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
Preferred: 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
DMV-local candidates preferred and willing/able to work onsite 2–3 days/week in the Tysons office

Benefits

Comp & perks

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
Flexible benefits package
Flexible work arrangements (remote availability)