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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.
