Healthcare Claims Payment Policy Managing Consultant
Core
Draft, standardize, and implement healthcare claims payment policies to improve payment accuracy, cost control, and compliance in a large payer environment.
Role type
Senior IC healthcare claims payment policy managing consultant
Builds
Reimbursement policies, claims rules, operational decision logic, and implementation guidance for payers and providers
Domain
Healthcare / Insurance / Public Policy
Required skills
Medicare/Medicaid/TRICARE policy knowledge, claims coding (CPT/HCPCS/ICDRGs/modifiers), fee schedule development, policy translation to operational rules, stakeholder management, data analysis
Preferred skills
Large federal health/payer environment experience, third-party administrator implementation support, claims impact analysis with SQL/Power BI/Tableau, team leadership
Technologies
Excel, Power BI, Tableau, SQL
