Job Description
Job Summary: The Claims Data Strategy Lead role is responsible for providing senior‑level, hands‑on leadership across complex healthcare claims data initiatives. This is a highly autonomous individual contributor role with full ownership accountability for identifying problems, driving solutions, and delivering outcomes with minimal oversight. The role requires rapid ramp‑up, strong technical judgment, and the ability to translate complex and disparate claims data into scalable, high‑performance analytics that directly support product, client, and business objectives. Key Responsibilities: Own and drive end‑to‑end solutions across healthcare claims data initiatives, from problem definition through implementation and validation. Serve as a senior authority on medical, pharmacy, behavioral health, dental, DME, and ancillary claims data, including experience with FACETs, BlueChip, Prime Therapeutics, ESI, and aggregated claims sources. Design, build, and optimize advanced SQL‑based data models, views, and automation frameworks with a focus on performance, scalability, and maintainability. Develop and maintain complex claim adjustment sequencing and disposition logic, including support for split claims and multiple, disparate source configurations. Build utilization metrics tied directly to underlying service‑level data, including inpatient, outpatient, professional, and behavioral health levels of care. Apply deep expertise in healthcare transactions and standards, including 837, 834, 820, HL7, and CCDA, to ensure data accuracy and analytical integrity. Independently assess unfamiliar data environments and rapidly develop a working understanding of new datasets using systematic, repeatable methodologies. Proactively identify data gaps, risks, and improvement opportunities and drive them to resolution without waiting for direction. Partner closely with product, analytics, engineering, and leadership teams to ensure claims data assets support broader business and client
