Medicare Claims Consultant

Overview

On Site
Hybrid
BASED ON EXPERIENCE
Contract - W2
Contract - Independent

Skills

System Implementation
Regulatory Compliance
Leadership
Systems Design
Medicare
Requirements Elicitation
Software Design
Collaboration
Management
Communication
Facilitation
Conflict Resolution
Problem Solving
FOCUS
Professional Services
Genetics
Law

Job Details

Job Title: Medicare Claims Integration Consultant
Location: Mostly Remote (Periodic Travel to Texas or California)
Duration: Approximately 5-7 months (to be confirmed)
Client: Regional Health Plan (Confidential)
Rate: $85 - $110 (Negotiable - based on candidate experience and location factors)

Position Overview:
We are seeking a highly skilled Medicare Claims Integration Consultant to support the implementation of a new claims processing platform for a regional health plan client in the Southwest. The ideal candidate will bring deep expertise in Medicare claims processing, system implementation, and business requirements definition, along with the ability to collaborate effectively with vendors and internal teams. This role will work closely with an engagement leader/project manager to ensure a successful delivery.

Key Responsibilities:

  • Lead and define requirements and business logic for the design and implementation of a new Medicare claims platform.
  • Provide subject matter expertise on Medicare claims processing, including compliance and operational best practices.
  • Advise leadership and functional teams on system design, technical solutions, and practical approaches to meet payer business needs.
  • Identify and communicate the critical path for a successful claims implementation.
  • Participate in and/or lead design sessions, requirements workshops, and solution validation.
  • Collaborate closely with vendors to ensure alignment on scope, timeline, and deliverables.
  • Support or lead aspects of claims platform system implementations or upgrades.
  • Partner with the project engagement leader to track progress, manage dependencies, and drive resolution of issues.

Qualifications:

  • Proven experience in Medicare claims processing with a focus on implementation or integration projects.
  • Strong track record in requirements gathering, business logic definition, and solution design for payer systems.
  • Experience leading or supporting claims platform implementations or upgrades.
  • Demonstrated ability to collaborate with vendors and manage cross-functional stakeholder relationships.
  • Excellent communication, facilitation, and problem-solving skills.
  • Willingness and ability to travel periodically to client sites in Texas or California.

About INSPYR Solutions
Technology is our focus and quality is our commitment. As a national expert in delivering flexible technology and talent solutions, we strategically align industry and technical expertise with our clients business objectives and cultural needs. Our solutions are tailored to each client and include a wide variety of professional services, project, and talent solutions. By always striving for excellence and focusing on the human aspect of our business, we work seamlessly with our talent and clients to match the right solutions to the right opportunities. Learn more about us at .

Equal Opportunity Employer
INSPYR Solutions provides Equal Employment Opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, INSPYR Solutions complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.

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About INSPYR Solutions