[Remote] Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid)

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Note: The job is a remote job and is open to candidates in USA. Dice is seeking a highly experienced Healthcare Claims Integration Consultant to support a strategic healthcare initiative focused on dual claims processing and payer integration. This role is critical for collaborating with executive leadership to design and implement a scalable approach for claims integration and cost efficiency in Medicare and Medicaid coordination.


Responsibilities

  • Lead design and advisory for dual claims strategy and integration frameworks
  • Support healthcare payer alignment involving Aetna, Medicare, and Medicaid
  • Analyze and optimize claims workflows, coordination of benefits (COB), and adjudication processes
  • Define and recommend operating models for cost reduction and claims efficiency
  • Collaborate with executive stakeholders to translate business needs into technical and operational solutions
  • Evaluate current-state claims processes and identify gaps, risks, and integration opportunities
  • Provide advisory support for payer integration during acquisition or organizational transition
  • Guide implementation strategy for claims data exchange and interoperability
  • Support development of roadmaps, governance models, and execution plans

Skills

  • 10+ years in healthcare payer/claims domain
  • Strong expertise in claims processing, adjudication, and payer operations
  • Hands-on experience with dual claims / coordination of benefits (COB)
  • Exposure to Medicare and Medicaid programs and regulatory frameworks
  • Experience working with or alongside Aetna or similar large national payers
  • Strong understanding of healthcare cost structures and reimbursement models
  • Experience in payer integration, healthcare transformation, or acquisition support
  • Ability to engage with CIO, VP, and executive-level stakeholders
  • Healthcare consulting background (Big 4 or boutique healthcare advisory)
  • Experience with claims platforms, payer systems, or healthcare data integration
  • Familiarity with EDI transactions (837/835), HIPAA compliance
  • Experience in large-scale payer modernization programs

Company Overview

  • Dice is a job-searching platform for technology professionals. It is a sub-organization of DHI Group. It was founded in 1990, and is headquartered in Santa Clara, California, USA, with a workforce of 201-500 employees. Its website is

    • Company H1B Sponsorship

  • Dice has a track record of offering H1B sponsorships, with 2 in 2022, 4 in 2021, 5 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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