8+ years of experience in healthcare claims analytics, payment accuracy, or reimbursement analysis.
Experience working with claims editing or payment accuracy vendors.
Strong expertise in medical coding, billing guidelines, and reimbursement methodologies.
Proven people leadership experience managing and developing analytics teams.
Requirements:
Lead and mentor a team of Implementation Claims Analysts, setting priorities, performance expectations, and development plans while standardizing analytical methodologies, reporting frameworks, and best practices for claims and reimbursement analysis.
Oversee large-scale claims data analysis (charge capture, reimbursement, underpayment/overpayment, and payment accuracy) and deliver exception-driven, actionable insights with clear client-facing reporting.
Partner with GTM, Customer Success, Product, and Engineering teams to align analytics deliverables with client goals and success metrics, influence roadmaps, and support renewals and expansions; serve as a senior analytics representative in client discussions.
Guide data ingestion and processing pipelines and oversee advanced analytics (SQL, PL/SQL, Python, Scala, Spark, AWS) to analyze billions of claims across clients, ensuring scalable, repeatable approaches and high accuracy.
Job description
Role Overview
The Senior Manager, Claims Analytics, leads the claims analytics function within the Implementation organization. This role is responsible for overseeing complex reimbursement and payment accuracy analyses, managing analysts, setting analytical standards, and partnering cross-functionally with GTM, Customer Success, Product, and Engineering teams to ensure successful client implementations.
This role combines deep healthcare claims expertise with people leadership, strategic thinking, and operational execution to scale analytics capabilities and drive measurable financial outcomes for clients.
Key Responsibilities
Leadership & Strategy
Lead and mentor a team of Implementation Claims Analysts, setting priorities, performance expectations, and development plans. Define and standardize analytical methodologies, reporting frameworks, and best practices for claims and reimbursement analysis.
Partner with Implementation leadership to align analytics deliverables with client goals, timelines, and success metrics.
Act as a subject-matter expert in claims analytics for complex or high-visibility client implementations.
Analytics & Execution
Oversee large-scale analysis of claims data related to charge capture, reimbursement, underpayment, overpayment, and payment accuracy.
Ensure the delivery of exception-driven, actionable insights that clearly identify systemic versus isolated issues.
Review and validate analytical outputs, ensuring accuracy, consistency, and clarity in reporting and client-facing deliverables.
Guide analyses related to:
Payor reimbursement behavior and trends
RVU productivity and payment alignment
Revenue cycle optimization opportunities
Financial performance to benchmarks, goals, and norms
Cross-Functional Collaboration
Partner with GTM and Customer Success teams to support implementations, renewals, and expansion opportunities through analytics insights.
Collaborate with Product and Engineering teams to influence roadmap priorities based on claims analysis findings and client needs.
Serve as a senior analytics representative in client-facing discussions, executive readouts, and strategic reviews.
Technical Oversight
Guide data ingestion and processing pipelines using SQL*Loader, Oracle, shell scripting, and cloud-based tools.
