Search Jobs | Dice.com

Job Details

Skills

Health Care
Payer
Claims
claims transformation
claims modernization
Facets
QNXT
HealthRules
Artificial Intelligence
Business Analysis
Business Operations
Agile

Summary

Job Description:

Senior Claims Domain Consultant with deep expertise in Healthcare Payer Claims Operations and working knowledge of Generative AI tools such as Claude, Copilot, ChatGPT, or similar LLM-based platforms.
The consultant will work closely with business, operations, technology, product, and client stakeholders to assess current claims processes, identify improvement opportunities, and define AI-enabled solutions that enhance claims accuracy, reduce manual effort, improve first-pass adjudication, and accelerate operational efficiency.
The ideal candidate should have strong understanding of medical claims, prior authorization, claim edits, denials, rework, provider/member data, payment integrity, and regulatory compliance, along with the ability to leverage GenAI tools like Claude for requirements analysis, process documentation, knowledge summarization, workflow optimization, and solution ideation.

Preferred Qualifications

Experience in claims transformation, claims modernization, or payer platform migration programs.
Experience with Facets, QNXT, HealthRules, or similar payer platforms.
Experience in AI-led healthcare transformation projects.
Exposure to automation tools, analytics platforms, or process mining tools.
Experience in consulting-led engagements, client workshops, and solution shaping.
Understanding of payer data models and claims data structures.
Certification in healthcare domain, business analysis, Agile, or AI/GenAI would be an added advantage.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 91099677
Position Id: 9030168
Posted 1 day ago

Fitment

Dice Job Match Score™

🛠️ Calibrating flux capacitors...

Contact the job poster

Anuradha Karod

Recruiter @ Talent Groups

View Profile

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Similar Jobs

Claims Business Consultant – Healthcare

Remote

•

20d ago

About VLink: Started in 2006 and headquartered in Connecticut, VLink is one of the fastest growing digital technology services and consulting companies. Since its inception, our innovative team members have been solving the most complex business, and IT challenges of our global clients. Job Title: Claims Business Consultant Healthcare Duration: 3 Months (Contract) Expected extension possible but not guaranteed. Required: 512+ years overall (Minimum 5 years of relevant experience in healthcare

Easy Apply

Contract

Depends on Experience

Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid)

Remote

•

27d ago

Overview Engagement Type: Remote High-priority, immediate start Start Timeline: ASAP (Target onboarding: Early-July) We are seeking a highly experienced Healthcare Claims Integration Consultant to support a strategic healthcare initiative focused on dual claims processing, payer integration, and cost optimization in collaboration with Aetna and related healthcare programs. This role is critical to supporting a large-scale healthcare transformation involving Medicare and Medicaid coordination, du

Easy Apply

Contract

$150,000 - $160,000

Senior Java Developer (Healthcare / Insurance Domain)

Remote

•

Today

Role: Senior Java Developer (Healthcare / Insurance Domain) Location: Remote Experience: 10+ Years Job Summary We are seeking a highly skilled Senior Java Developer with strong experience in the Healthcare or Insurance domain. The ideal candidate should have hands-on expertise in building scalable enterprise applications using Java technologies and possess a solid understanding of EDI transactions, insurance claims processing, member enrollment, provider data management, or payer systems. Exper

Easy Apply

Full-time, Third Party

$0 - $0

Senior Data Analyst

Remote or Long Beach, California

•

Today

Job Description JOB DESCRIPTION This role will be a member of the Payment Integrity Analytics team who is responsible for creating and maintaining a post pay review of claims, members, and providers to ensure accurate billing. Our team creates Post Pay Concepts (Analytics) that identify inaccurately billed claims with potential overpayments for correction and perhaps reduction of payment. At times we will also build reports and identify insights for tracking operations of running and monitorin

Full-time

USD 54,373.27 - 117,808.76 per year

Filter Results

Job post features

Posted date

Work settings

Employment type

Distance

Employer type

Work authorization

Senior Healthcare Claims Consultant

Skills

Summary

Dice Job Match Score™

Anuradha Karod

Similar Jobs

Senior Healthcare Claims Consultant

Job Details

Skills

Summary

Dice Job Match Score™

Anuradha Karod

Similar Jobs