Consulting (1)

Description

Claims Lead

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.S. and 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

As a Claims Lead, you willwork withUShealthcare payerclientstoidentifyopportunities that reduce medical and administrative costs, improve payment accuracy, and strengthenoperational performance.You will help clientsunderstandbusinessissues, dig into the data, and developrecommendationsthat can be put into action. We are looking for someone who is comfortable going deep on unfamiliar payer topics, knows how to research quickly and thoughtfully, and can connect the dots across claims, operations, reimbursement, and client priorities.

Work You’ll Do

Research payer topics, industry trends, regulations, operating models, and client-specific business issues.
Review and analyze medical, pharmacy, eligibility, provider, pricing, reimbursement, and other healthcare data to find trends, issues, and opportunities.
Use SQL and other tools to work through large datasets and evaluateutilization, cost drivers, reimbursement patterns, payment accuracy, and operational performance.
Check data quality, test assumptions, document the logic behind the analysis, and make sure the work can stand up to client review.
Develop recommendations, business cases, and implementation plans tied to cost savings, process improvement, medical cost management, and operational efficiency.
Build practical points of view on payer topics such as claims, provider networks, reimbursement, payment integrity,utilizationmanagement, prior authorization, medical management, member experience, risk adjustment, Stars/quality, value-based care, and payer operations.
Take loosely defined problems and turn them into a clear workplan byidentifyingthe right questions, data sources, research sources, and decision points.
Create presentations, summaries, dashboards, and reports that clearly explain what the analysis shows and what actions the client should consider.
Lead workstreams, manage day-to-day analysis, and coordinate with client stakeholders, vendors, and internalAAreteteams.
Explain technical findings in plain business language during client meetings and internal working sessions.
Coach Analysts, Interns, and global support teams by assigning work, reviewing outputs, and helping the team deliver better work faster.
Identifyrelated client needs and bring them to leadership whenadditionalAAretesupport may be useful.
Bring sound judgment, ownership, curiosity, and a hands-on problem-solving mindset to each engagement.
Other duties as assigned

Requirements

10+ years of experienceinhealthcare analytics, payer operations, claims analytics, healthcare operations, or a similar client-facing role.
Bachelor’s degreerequired, or equivalent experience.
Strong understanding of healthcare claims data, health plan data, payer processes, provider data, reimbursement concepts, and claims data structures.
GoodSQL skills and experience working with large datasets. Experience with Snowflake, Excel, or similar tools is helpful.
Advanced Excel and PowerPoint skills, with the ability to create clean, client-ready analysis and presentations.
Experience with BI tools such as Power BI or Tableau, including dashboards, reports, or recurring analytics outputs.
Strong analytical skills and the ability to move from data to insights, recommendations, and business cases.
Excellent research skills, including the ability to learn unfamiliar payer topics, evaluate sources, pull out what matters, and explain the business implications clearly.
Ability to contribute across a broad payer agenda, including claims, benefits, provider data, contracting, reimbursement, payment integrity, medical cost management,utilizationmanagement, prior authorization, risk adjustment, quality, Stars, member/provider experience, and operational transformation.
Strong written and verbal communication skills, with the ability to explain complex analysis to both business and client audiences.
Comfort working in fast-moving project environments with internal teams, clients, and vendors.
High ownership, curiosity, accountability, and openness to feedback.

Preferred Qualifications

Direct payer experience is strongly preferred.
Experience with claims analytics and/or network analytics, including payer/provider contracts, reimbursement language, and common contract terms.
Exposure to medical management,utilizationmanagement, prior authorization, clinical operations, or related payer/provider functions.
Experience with healthcare platforms such as provider data management systems, claims adjudication systems,Facets, QNXT, or similar toolswould be an advantage.
Familiarity with healthcare coding systems, including CPT, HCPCS, ICD, DRG, and APC.
Strongknowledge of Medicare and Medicaid policies, regulations, and operating considerations.
Experience with professional and facility claims.
Experience with cost reduction, payment accuracy, process improvement, or operational transformation work in healthcare.

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

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, OpenAI ChatGPT, Anthropic Claude, Google Gemini, LinkedIn Recruiter AI and Hiring Assistant, Jobvite Talent Fit and AAreteHireSense. 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.

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