Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid)
Posted Today by Progressive Computer Solutions
Negotiable
Undetermined
Remote
Remote
Summary: The Healthcare Claims Integration Consultant will play a pivotal role in a strategic healthcare initiative focused on dual claims processing, payer integration, and cost optimization, particularly in collaboration with Aetna and related programs. This remote position requires extensive experience in healthcare claims and payer operations, with responsibilities that include designing integration frameworks and optimizing claims workflows. The consultant will work closely with executive leadership to implement scalable solutions for claims integration and efficiency. Immediate availability is preferred, with onboarding targeted for early July.
Key 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
Key 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
Salary (Rate): £112,500 yearly
City: undetermined
Country: undetermined
Working Arrangements: remote
IR35 Status: undetermined
Seniority Level: undetermined
Industry: Other
Overview
Engagement Type: Remote High-priority, immediate start
Start Timeline: ASAP (Target onboarding: Early-July)
We are seeking a highly experienced Healthcare Claims Integration Consultant to support a strategic healthcare initiative focused on dual claims processing, payer integration, and cost optimization in collaboration with Aetna and related healthcare programs.
This role is critical to supporting a large-scale healthcare transformation involving Medicare and Medicaid coordination, dual claims strategy, and payer operational alignment.
The consultant will work closely with executive leadership (CIO/President level stakeholders) to design and implement a scalable approach for claims integration and cost efficiency.
Key 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
Required Experience
- 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
Preferred Experience
- 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
Soft Skills
- Strong executive communication and stakeholder management
- Strategic thinking with ability to operate in ambiguous environments
- Ability to bridge business, clinical, and technical teams
- Problem-solving mindset with focus on measurable cost impact
Ideal Candidate Profile
A senior healthcare domain expert who has:
- Designed or led claims integration or dual claims programs
- Worked with large payer ecosystems (Aetna strongly preferred)
- Delivered cost optimization and operational transformation in healthcare claims environments