Manager, Claims Analytics

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.S., India, and Europe. 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 seeking a Manager, Claims Analytics to lead analytic workstreams that help health plans better understand their claims data, uncover cost and utilization trends, improve reimbursement accuracy, and enhance overall operational performance. This individual will manage project delivery, mentor team members, and develop analytic solutions that generate meaningful insights for payer and provider clients.

This role requires strong experience working with healthcare claims data, technical and analytical expertise, and the ability to translate complex findings into clear, actionable recommendations for stakeholders.

Work You’ll Do

• Lead day-to-day delivery of claims analysis projects for multiple payer and provider clients
• Design analytic approaches that evaluate utilization, cost drivers, reimbursement patterns, and operational opportunities
• Develop advanced SQL queries, data models, and automated workflows to create scalable analytic solutions
• Guide managers and consultants in working with complex datasets including medical, pharmacy, eligibility, provider, and pricing files
• Validate data accuracy, ensure consistency across multiple data sources, and maintain rigorous quality checks
• Build dashboards and reporting frameworks using BI tools to support client decision making
• Translate large volumes of claims data into clear, compelling insights tailored to executive-level stakeholders
• Manage project plans, timelines, and prioritization across concurrent engagements
• Partner with clients to understand goals, develop custom analyses, and make strategic recommendations
• Support business development through proposals, scoping discussions, and client presentations
• Contribute to internal best practices, methodologies, and analytics frameworks
• Other duties as assigned

Requirements

• 7+ years of experience in claims analytics, healthcare data analytics, actuarial analysis, or payer/provider operations with a Bachelor’s Degree, or 11+ years of equivalent experience
• Demonstrated experience leading project teams or mentoring analysts and consultants
• Strong experience analyzing healthcare claims datasets, including medical and pharmacy
• Understanding of reimbursement methodologies across Medicare, Medicaid, Commercial, and other lines of business
• Proficiency in SQL or similar query languages used to analyze complex datasets
• Ability to identify trends, anomalies, utilization patterns, and cost drivers within claims data
• Working knowledge of healthcare coding and reimbursement structures including CPT, HCPCS, ICD, DRG, APC, and fee schedules
• Experience with BI tools such as Power BI, Tableau, or Qlik
• Strong communication skills with ability to explain analytic findings clearly
• Advanced proficiency in Excel or equivalent data tools
• Knowledge of payer operations, provider contracting concepts, and healthcare financial analysis