Healthcare Data & Business Consultant

Remote | 12+ Years Experience

Seeking an experienced consultant with strong Healthcare Payer domain + hands-on data expertise.

Responsibilities:

• Strong Payer experience across Actuarial, Underwriting & HEDIS/Quality
• Handle Claims, Membership, Provider, Premium & Cost/Utilization data
• Knowledge of PMPM, IBNR, Risk Adjustment, MLR, Utilization & Medical Cost
• Utilize strong SQL, Data Analysis, Data Profiling & Validation
• Understanding of Data Architecture, Data Lineage & End-to-End Data Flows
• Experience with Business Rules, Data Mapping, Definitions & Reverse Engineering
• Ability to bridge Business SMEs and Technical/Data Teams

Requirements:

Must Have:

• Strong Payer experience across Actuarial, Underwriting & HEDIS/Quality
• Claims, Membership, Provider, Premium & Cost/Utilization data
• Knowledge of PMPM, IBNR, Risk Adjustment, MLR, Utilization & Medical Cost
• Strong SQL, Data Analysis, Data Profiling & Validation
• Understanding of Data Architecture, Data Lineage & End-to-End Data Flows
• Experience with Business Rules, Data Mapping, Definitions & Reverse Engineering
• Ability to bridge Business SMEs and Technical/Data Teams

Preferred: Snowflake, Semantic Modeling, Metadata/Business Glossary, Healthcare Data Modernization, AI/Data Analytics.