Manager - Claims Analytics

Description

Manager - Claims Analytics

AArete is one-of-a-kind when it comes to consulting firm culture.

We’re a global, innovative management and technology consulting firm with offices in the U.Sand India. Our name comes from the Greek word for excellence: “Areté.”And excellence is exactly what we strive for.

We’re celebrating our fourth year as one of Forbes’ World’s Best Management Consulting Firms- and our success starts with our people.From robust career development planning to competitive life and wellness benefits, AArete’s “Culture of Care” takes a holistic approach to the employee experience.

AAretians (our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing personal development and fulfillment.

The Role

We are looking for a Manager, Claims Analytics with strong healthcare knowledge and experience leading solutions. This person should be able to understand complex payer and provider problems, decide how to solve them, and guide the technical team with minimal support. They will lead the work from the initial analysis through development, testing, and delivery.

The right person will know healthcare claims, reimbursement, payer operations, and provider finances in depth. They should be comfortable working through unclear problems, setting a clear direction, and getting results through the team. They will also coach team members, solve delivery issues, and explain findings and recommendations clearly to senior leaders.

WorkYou’llDo

• Lead healthcare claims and analytics projects from understanding the problem through implementation and measuring results
• Use payer and provider knowledge to understand unclear business questions, choose the right approach, and make decisions with minimal guidance
• Give the technical team clear direction on data needs, analysis, solution design, timelines, and expected results
• Coach analysts, consultants, data engineers, and developers on healthcare topics, problem solving, and delivery
• Manage day-to-day delivery across payer and provider projects by setting priorities, removing blockers, managing dependencies, and keeping the team on schedule
• Analyze utilization, cost trends, reimbursement, network and provider performance, payment accuracy, and areas for improvement
• Guide the team in using medical and pharmacy claims, eligibility, provider, contract, pricing, and reference data
• Review data models, SQL, analysis, workflows, dashboards, and final outputs to make sure they are accurate, practical, and suitable for the business need
• Set clear checks for data and analysis quality, compare results across sources, and document assumptions and limits
• Set success measures, track progress, and change the approach when needed to deliver results
• Turn large amounts of healthcare data into clear findings and recommendations for decision makers
• Work with clients and internal teams to confirm goals, question assumptions, manage expectations, and agree on next steps
• Support proposals, project scope, estimates, demonstrations, and client presentations with a strong healthcare point of view
• Build reusable methods, guides, and tools that help the team deliver healthcare analytics work consistently
• Creating business documents and presenting to stakeholders
• Other duties as assigned

Requirements

• 12+ years of experience in healthcare analytics, payer operations, claims analytics, consulting, or solution delivery, with a bachelor’s or master’s degree

• Strong knowledge of US healthcare, including payer operations, provider finances, benefit design, reimbursement, claims data, and claims processing

• Able to understand complex or unclear business problems, decide on a solution, and lead a technical team with minimal guidance

• A strong record of delivering results by setting priorities, managing risks and dependencies, maintaining quality, and completing work on time

• Strong analytical skills and the ability to ask the right questions, find trends and unusual results, test assumptions, and turn data into useful findings

• Hands-on experience with medical and pharmacy claims, eligibility, provider, pricing, and related healthcare data

• Good understanding of reimbursement methods across Medicare, Medicaid, Commercial, and other lines of business

• Knowledge of CPT, HCPCS, ICD, DRG, APC, revenue codes, modifiers, and fee schedules etc.

• Experience coaching analysts, consultants, data engineers, and developers and giving clear, useful feedback

• Able to review and question technical designs, data models, SQL, analysis, and outputs without being the main developer

• Good SQL skills and working knowledge of Power BI, Excel, or similar tools

• Clear communication and stakeholder management skills, with the ability to explain complex work to both technical teams and senior leaders

• Knowledge of payer operations, provider contracting, healthcare financial analysis, and the checks needed to deliver accurate results

• Familiarity with concepts such as Total Cost of Care (TCoC), Value Based Care (VBC), Provider Networks, and Payment Integrity will be an added advantage

• Extensive experience with healthcare data and how to use it to generate useful insights and present to stakeholders

• Should be a team player

Preferred Requirements

• Experience supporting practice growth, solution development, or analytics capability expansion

• Experience designing automated analytic workflows or ETL processes

• Experience with SQL Server, SSIS, Python, Snowflake, or similar data environments Familiarity with data warehousing concepts and healthcare data architecture

• Experience building visual analytics dashboards for ongoing monitoring and reporting.

Benefits

• Flexible Paid Time Off of up to 23 days annually, in addition to 10 paid public holidays
• Hybrid work model with flexible in-office attendance
• Comprehensive health benefits including medical insurance (Mediclaim), personal accident insurance, and term life insurance
• Generous paid parental leave program
• Attractive employee referral bonus scheme
• Transportation allowance and night shift allowance
• Employee advance salary loan facility
• Structured professional certification reimbursement policy to support ongoing learning and development

AArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available.

We put humans at the center of our work

We’re a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results.

But what sets us apart is our people. We are guided by our deeply embedded guiding principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion.

And we’ve been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine.

We’ve earned a Great Place to Work Certification™ and been named a World’s Best Management Consulting Firm by Forbes, Vault’s Top 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000’s Fastest Growing Firms, and Consulting Magazine's Fastest Growing Firms.

Learn more about our award-winning culture

AArete, LLC (“AArete”) may utilize Artificial Intelligence/Automated Decision-Making Technology/Automated Employment Decision Technology tools and resources (“AI” or “tools” or “resources”) to assist humans in generating job descriptions and postings, recruitment, analyzation of information, screening candidates, evaluation of candidate information, and assisting humans in the selection of potential candidates by all levels of AArete employees for all positions.

AArete may use Microsoft Co-Pilot,OpenAIChatGPT, Anthropic Claude, Google Gemini, LinkedIn Recruiter AI and Hiring Assistant, Jobvite Talent Fit and AArete HireSense. AArete may use all the information you provide. Submission of information to AArete shall serve as consent to AArete’s use of AI tools and resources. AArete complies with all applicable law and does not use AI to discriminate against any individual and does not use location or geographic data like zip codes to act in a discriminatory or illegal manner. Your personal data may be used in relation to prospective employment with AArete and will only be retained for so long as legally necessary.

AArete shall comply with its posted privacy policies and candidates may contact Recruiting or Privacy Departments, as identified below, to request accommodations or to exercise any of your applicable rights, pursuant to applicable law:

Recruiting:[email protected]

Privacy:[email protected]

We are an Equal Employment Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.