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Showing 6 Unitedhealth Group jobs in Chicago
Senior Health Economist - Managed Care
60684 Chicago, Illinois
Elevance Health
Posted 2 days ago
Job Viewed
Job Description
**Senior Health Economist - Managed Care**
**Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
_PLEASE NOTE: This position is not eligible for current or future visa sponsorship._
Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.
The **Senior Health Economist (** Advanced Analytics Analyst Senior) measures financial performance of core Carelon products leveraging claims, authorization, and membership data to tell a detailed story to respective business stakeholders. The Senior Health Econonmis creates statistical models to predict, classify, quantify, and/or forecast business metrics. Design modeling studies to address specific business issues determined by consultation with business partners.
**How you will make an impact:**
+ Prepares analytical data sets in support of modeling studies. Build, test, and validate statistical models.
+ Publishes results and addresses constraints/limitations with high-level business partners.
+ Proactively collaborates with business partners to determine identified population segments.
+ Develop actionable plans to enable the identification of patterns related to quality, use, cost, and other variables.
**Minimum Requirements:**
+ Requires MS, MA, or PhD with concentration in a quantitative discipline such as statistics, computer science, cognitive science, economics, or operations research, a minimum of 3 years direct experience programming large, multi-source datasets with SAS required, and a minimum of 3 years in health care setting; or any combination of education and experience which would provide an equivalent background.
**Preferred Skills, Capabilities, and Experiences:**
+ Actuarial sciences background highly preferred.
+ Utilization Management experience preferred.
+ Medical economics, provider finance, healthcare analytics, and/or financial services highly preferred.
+ Comprehensive understanding of medical claims data.
+ Intermediate to Advanced expertise with SQL, SQL Server, Teradata, or equivalent strongly preferred.
+ Proven ability to design modeling studies and experience with data models, addressing data quality issues in study design, and constructing robust and efficient analytical data sets strongly preferred.
+ Significant experience in a healthcare-related field strongly preferred.
+ The ability to present meaningful results to a business audience, to participate collaboratively in a team tasked to produce complex analyses on a rigorous schedule, to communicate with strong written and verbal communication skills, and to present to large multi-disciplinary audiences regularly strongly preferred.
**For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $84,740 to $160,560.**
**Locations: California, Colorado, District of Columbia (Washington, DC), Illinois, Minnesota, New York, Washington State**
**In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.**
*** The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.**
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
**Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
_PLEASE NOTE: This position is not eligible for current or future visa sponsorship._
Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.
The **Senior Health Economist (** Advanced Analytics Analyst Senior) measures financial performance of core Carelon products leveraging claims, authorization, and membership data to tell a detailed story to respective business stakeholders. The Senior Health Econonmis creates statistical models to predict, classify, quantify, and/or forecast business metrics. Design modeling studies to address specific business issues determined by consultation with business partners.
**How you will make an impact:**
+ Prepares analytical data sets in support of modeling studies. Build, test, and validate statistical models.
+ Publishes results and addresses constraints/limitations with high-level business partners.
+ Proactively collaborates with business partners to determine identified population segments.
+ Develop actionable plans to enable the identification of patterns related to quality, use, cost, and other variables.
**Minimum Requirements:**
+ Requires MS, MA, or PhD with concentration in a quantitative discipline such as statistics, computer science, cognitive science, economics, or operations research, a minimum of 3 years direct experience programming large, multi-source datasets with SAS required, and a minimum of 3 years in health care setting; or any combination of education and experience which would provide an equivalent background.
**Preferred Skills, Capabilities, and Experiences:**
+ Actuarial sciences background highly preferred.
+ Utilization Management experience preferred.
+ Medical economics, provider finance, healthcare analytics, and/or financial services highly preferred.
+ Comprehensive understanding of medical claims data.
+ Intermediate to Advanced expertise with SQL, SQL Server, Teradata, or equivalent strongly preferred.
+ Proven ability to design modeling studies and experience with data models, addressing data quality issues in study design, and constructing robust and efficient analytical data sets strongly preferred.
+ Significant experience in a healthcare-related field strongly preferred.
+ The ability to present meaningful results to a business audience, to participate collaboratively in a team tasked to produce complex analyses on a rigorous schedule, to communicate with strong written and verbal communication skills, and to present to large multi-disciplinary audiences regularly strongly preferred.
**For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $84,740 to $160,560.**
**Locations: California, Colorado, District of Columbia (Washington, DC), Illinois, Minnesota, New York, Washington State**
**In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.**
*** The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.**
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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0
Principal Network Management Consultant - Managed Care
60684 Chicago, Illinois
Health Care Service Corporation
Posted 2 days ago
Job Viewed
Job Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
**Job Summary**
This is a hybrid position working 3 days a week in the office.
This position is responsible for provider recruitment and contracting of physicians, physician groups and facilities including large or complex groups/facilities (large independent hospital systems, integrated & non-integrated systems, value based contracting, etc). Develop and negotiate contracts. Develop and maintain relationships with providers. Ensure strategic coverage for assigned territory. Responsible for education of providers and for ongoing provider service. Provide subject matter expertise to improve efficiencies and results.
NOTE: This hybrid role (3 days in office) in CHICAGO IL.
JOB REQUIREMENTS:
*Bachelor Degree and 4 years provider contracting experience OR Master degree and 3 years contracting experience OR 8 years business experience including 4 years provider contracting experience. Contracting experience involves negotiating reimbursements, financial arrangements and rates.
*Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
*Negotiation skills.
*Relationship building skills.
*Knowledge of marketplace.
*Meet deadlines and work well under pressure.
*Verbal and written communication skills to interact with all levels of corporate personnel and providers.
*PC proficiency to include Microsoft Office.
*Analytical skills and business acumen to analyze financial data to determine financial impact of negotiations.
*Ability and willingness to travel within assigned areas of responsibility, including overnight stays.
#LI-MK1
#INCR
**Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!**
**Pay Transparency Statement:**
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
**HCSC Employment Statement:**
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
**Base Pay Range**
$90,900.00 - $164,200.00
Exact compensation may vary based on skills, experience, and location.
**Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.**
**Join our Talent Community. ( more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.
Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.
HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.
If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at to request reasonable accommodations.
Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.
Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association
© Copyright 2025 Health Care Service Corporation. All Rights Reserved.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
**Job Summary**
This is a hybrid position working 3 days a week in the office.
This position is responsible for provider recruitment and contracting of physicians, physician groups and facilities including large or complex groups/facilities (large independent hospital systems, integrated & non-integrated systems, value based contracting, etc). Develop and negotiate contracts. Develop and maintain relationships with providers. Ensure strategic coverage for assigned territory. Responsible for education of providers and for ongoing provider service. Provide subject matter expertise to improve efficiencies and results.
NOTE: This hybrid role (3 days in office) in CHICAGO IL.
JOB REQUIREMENTS:
*Bachelor Degree and 4 years provider contracting experience OR Master degree and 3 years contracting experience OR 8 years business experience including 4 years provider contracting experience. Contracting experience involves negotiating reimbursements, financial arrangements and rates.
*Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
*Negotiation skills.
*Relationship building skills.
*Knowledge of marketplace.
*Meet deadlines and work well under pressure.
*Verbal and written communication skills to interact with all levels of corporate personnel and providers.
*PC proficiency to include Microsoft Office.
*Analytical skills and business acumen to analyze financial data to determine financial impact of negotiations.
*Ability and willingness to travel within assigned areas of responsibility, including overnight stays.
#LI-MK1
#INCR
**Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!**
**Pay Transparency Statement:**
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
**HCSC Employment Statement:**
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
**Base Pay Range**
$90,900.00 - $164,200.00
Exact compensation may vary based on skills, experience, and location.
**Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities.**
**Join our Talent Community. ( more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.
Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.
HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.
If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at to request reasonable accommodations.
Please note that only **requests for accommodations in the application process** will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.
Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association
© Copyright 2025 Health Care Service Corporation. All Rights Reserved.
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1
Claim Counsel, Managed Care and Healthcare
60684 Chicago, Illinois
Travelers Insurance Company
Posted 2 days ago
Job Viewed
Job Description
**Who Are We?**
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim, Legal
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$111,600.00 - $184,200.00
**Target Openings**
1
**What Is the Opportunity?**
Bond & Specialty Insurance (BSI) provides management and professional liability, cyber, crime insurance, and surety bonds to or on behalf of businesses of all sizes. The BSI Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to optimize claim results. Travelers' PNP Programs Team provides coverage for Community Associations, Healthcare Institutions and Providers, Managed Care Organizations, Life and Health Underwriters and Public Adjusters. As a valued member of our team, in addition to claim, you also will provide legal advice to our underwriting colleagues and non-attorney claim colleagues, and participate in BSI claim strategic initiatives.
**What Will You Do?**
+ Follow operational policies to analyze, investigate, and resolve BSI claims of varying levels of severity with moderate supervision from claims management.
+ Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.
+ Retain, monitor, and manage outside counsel actively utilizing litigation management plans and budgets.
+ Communicate with underwriting on significant claim exposures.
+ Continue to develop the ability to identify all recovery opportunities and coordinate recovery efforts with the Recovery Management Unit and Claim management.
+ Travel to and attend mediations, settlement conferences, claim conferences, field office visits, trials and depositions.
+ Refine policy interpretation/coverage analysis skills including drafting coverage opinions with case law included.
+ Strengthen the ability to negotiate settlements/resolutions, review releases and settlement agreements, including confidentiality and non-disclosure provisions.
+ Support underwriting marketing efforts, including participation in broker and account visits and risk mitigation seminars and authoring customer-focused white papers and articles.
+ Monitor marketplace conditions, conduct research, and draft reference materials to inform claim and underwriting colleagues on law impacting Travelers' underwriting and claim decisions.
+ Obtain and maintain required adjusters' licenses.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Five or more years of relevant legal or claim handling work experience.
+ Demonstrated ability to effectively work through conflict and resolve issues with a professional demeanor.
+ Ability to make sound decisions and negotiate terms and conditions within designated authority limit.
+ Strong verbal and written communication skills with the ability to clearly articulate coverage determinations.
+ Time management skills with the ability to manage multiple priorities with an attention to detail, data and analytics.
+ Ability to build and maintain effective and collaborative relationships with colleagues, customers, and business partners.
**What is a Must Have?**
+ Bachelor's Degree.
+ Juris Doctorate Degree.
+ Properly licensed, registered or authorized, and in good standing, to practice law in the jurisdiction in which you will be working.
+ Two years of relevant legal experience.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ( ) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit .
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim, Legal
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$111,600.00 - $184,200.00
**Target Openings**
1
**What Is the Opportunity?**
Bond & Specialty Insurance (BSI) provides management and professional liability, cyber, crime insurance, and surety bonds to or on behalf of businesses of all sizes. The BSI Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to optimize claim results. Travelers' PNP Programs Team provides coverage for Community Associations, Healthcare Institutions and Providers, Managed Care Organizations, Life and Health Underwriters and Public Adjusters. As a valued member of our team, in addition to claim, you also will provide legal advice to our underwriting colleagues and non-attorney claim colleagues, and participate in BSI claim strategic initiatives.
**What Will You Do?**
+ Follow operational policies to analyze, investigate, and resolve BSI claims of varying levels of severity with moderate supervision from claims management.
+ Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.
+ Retain, monitor, and manage outside counsel actively utilizing litigation management plans and budgets.
+ Communicate with underwriting on significant claim exposures.
+ Continue to develop the ability to identify all recovery opportunities and coordinate recovery efforts with the Recovery Management Unit and Claim management.
+ Travel to and attend mediations, settlement conferences, claim conferences, field office visits, trials and depositions.
+ Refine policy interpretation/coverage analysis skills including drafting coverage opinions with case law included.
+ Strengthen the ability to negotiate settlements/resolutions, review releases and settlement agreements, including confidentiality and non-disclosure provisions.
+ Support underwriting marketing efforts, including participation in broker and account visits and risk mitigation seminars and authoring customer-focused white papers and articles.
+ Monitor marketplace conditions, conduct research, and draft reference materials to inform claim and underwriting colleagues on law impacting Travelers' underwriting and claim decisions.
+ Obtain and maintain required adjusters' licenses.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Five or more years of relevant legal or claim handling work experience.
+ Demonstrated ability to effectively work through conflict and resolve issues with a professional demeanor.
+ Ability to make sound decisions and negotiate terms and conditions within designated authority limit.
+ Strong verbal and written communication skills with the ability to clearly articulate coverage determinations.
+ Time management skills with the ability to manage multiple priorities with an attention to detail, data and analytics.
+ Ability to build and maintain effective and collaborative relationships with colleagues, customers, and business partners.
**What is a Must Have?**
+ Bachelor's Degree.
+ Juris Doctorate Degree.
+ Properly licensed, registered or authorized, and in good standing, to practice law in the jurisdiction in which you will be working.
+ Two years of relevant legal experience.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ( ) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit .
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2
Healthcare Consulting Sr Director - Managed Care & Payment Strategy
60684 Chicago, Illinois
Huron Consulting Group
Posted today
Job Viewed
Job Description
Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
At Huron, a Senior Director leads with expertise and collaboration, partnering with Huron and client leaders to create sustainable solutions that drive meaningful results. As a Senior Director with our Healthcare team, you will lead complex healthcare consulting engagements, creating high-performing environments and ensuring successful client outcomes. You'll manage engagement-wide economics, apply critical thinking to quantify benefits, and develop solutions for performance improvement initiatives.
Your role will foster a supportive, inclusive environment, empowering team members and creating a workplace where diverse perspectives are valued. You will build strong executive-level relationships, lead change processes, and identify new business opportunities, leveraging Huron's capabilities to meet client objectives. This allows you to make an impact and provides career opportunities both within and beyond your areas of expertise.
If you're passionate about driving impactful solutions and believe in the power of collaboration, Huron offers a rewarding path forward.
As the Healthcare Consulting Senior Director - Managed Care & Payment Strategy, you will:
+ Lead complex healthcare consulting engagements, creating collaborative, high-performing environments, and ensuring successful client outcomes.
+ Manage engagement-wide economics, including budgets, revenue forecasting, margins, invoicing, and billing.
+ Apply analytical and critical thinking skills to quantify benefits, identify risks, and develop solutions for initiatives impacting a healthcare organization's contractual relationships with payers and overall reimbursement level.
+ Communicate effectively to understand client challenges, create customized solutions, manage client expectations, deliver impactful presentations and proposals.
+ Build strong executive-level relationships, lead change processes, and identify new business opportunities, leveraging Huron's capabilities to meet client objectives.
Requirements:
+ Bachelor's degree required
+ Minimum of 10 years of relevant experience, including at least 5 years of progressive healthcare management consulting experience. A combination of consulting and senior leadership roles within provider organizations may be considered, but strong healthcare consulting experience is essential.
+ Demonstrated expertise in fee-for-service payer contracting and reimbursement, including Traditional ("Original") Medicare reimbursement/payment systems, as well as with innovative payment models, negotiating complex payer reimbursement contracts for provider organizations, understanding reimbursement methodology impact on net patient service revenue, and driving revenue performance improvement for a variety of healthcare organizations. (Huron's clients range from national/regional integrated delivery systems and academic medical centers to critical access hospitals, as well as ambulatory surgery centers and single- or multi- specialty medical groups.)
+ Extensive experience in designing and contracting for value- and risk- based payments and alternative payment models, including value-based readiness assessments, care model design, ACO development (e.g., MSSP, ACO REACH, Commercial shared risks), Medicaid managed care participation. Experience with population health initiatives such as patient-centered medical homes (and other characteristics of enhanced primary care) as well as contracting vehicles (clinically integrated networks (CINs) and/or independent provider networks (IPAs))
+ Proven commitment to team development and engagement through effective coaching, talent development, and retention strategies, with a strong ability to deliver actionable, timely feedback that drives performance.
+ The ability to travel based on client, enterprise, or project needs is an essential function of this role. While travel requirements may vary based on business need, the current average travel in the Healthcare practice is less than 50%, annually.
+ Proficiency in Microsoft Office (Word, PowerPoint, Excel)
+ US Work Authorization Required
Preferences:
+ Master's degree or equivalent experience
+ Experience in a matrixed organization or cross-functional team environment
+ Exposure to clinical care delivery in a hospital and/or medical group, to understand the interplay between providing care and reimbursement
+ Experience with institutional, professional, and/or global capitation arrangements, including the contracting and economic mechanisms (i.e., division of financial responsibilities (DOFR)
The estimated base salary range for this job is $215,000 - $65,000. The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting. The actual salary paid to an individual will vary based on multiple factors, including but not limited to specific skills or certifications, years of experience, market changes, and required travel. This job is also eligible to participate in Huron's annual incentive compensation program, which reflects Huron's pay for performance philosophy. Inclusive of annual incentive compensation opportunity, the total estimated compensation range for this job is 268,750 - 350,750. The job is also eligible to participate in Huron's benefit plans which include medical, dental and vision coverage and other wellness programs. The salary range information provided is in accordance with applicable state and local laws regarding salary transparency that are currently in effect and may be implemented in the future.
**Position Level**
Senior Director
**Country**
United States of America
At Huron, we're redefining what a consulting organization can be. We go beyond advice to deliver results that last. We inherit our client's challenges as if they were our own. We help them transform for the future. We advocate. We make a difference. And we intelligently, passionately, relentlessly do great work.together.
Are you the kind of person who stands ready to jump in, roll up your sleeves and transform ideas into action? Then come discover Huron.
Whether you have years of experience or come right out of college, we invite you to explore our many opportunities. Find out how you can use your talents and develop your skills to make an impact immediately. Learn about how our culture and values provide you with the kind of environment that invites new ideas and innovation. Come see how we collaborate with each other in a culture of learning, coaching, diversity and inclusion. And hear about our unwavering commitment to make a difference in partnership with our clients, shareholders, communities and colleagues.
Huron Consulting Group offers a competitive compensation and benefits package including medical, dental, and vision coverage to employees and dependents; a 401(k) plan with a generous employer match; an employee stock purchase plan; a generous Paid Time Off policy; and paid parental leave and adoption assistance. Our Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year. All benefits and programs are subject to applicable eligibility requirements.
Huron is fully committed to providing equal employment opportunity to job applicants and employees in recruitment, hiring, employment, compensation, benefits, promotions, transfers, training, and all other terms and conditions of employment. Huron will not discriminate on the basis of age, race, color, gender, marital status, sexual orientation, gender identity, pregnancy, national origin, religion, veteran status, physical or mental disability, genetic information, creed, citizenship or any other status protected by laws or regulations in the locations where we do business. We endeavor to maintain a drug-free workplace.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
At Huron, a Senior Director leads with expertise and collaboration, partnering with Huron and client leaders to create sustainable solutions that drive meaningful results. As a Senior Director with our Healthcare team, you will lead complex healthcare consulting engagements, creating high-performing environments and ensuring successful client outcomes. You'll manage engagement-wide economics, apply critical thinking to quantify benefits, and develop solutions for performance improvement initiatives.
Your role will foster a supportive, inclusive environment, empowering team members and creating a workplace where diverse perspectives are valued. You will build strong executive-level relationships, lead change processes, and identify new business opportunities, leveraging Huron's capabilities to meet client objectives. This allows you to make an impact and provides career opportunities both within and beyond your areas of expertise.
If you're passionate about driving impactful solutions and believe in the power of collaboration, Huron offers a rewarding path forward.
As the Healthcare Consulting Senior Director - Managed Care & Payment Strategy, you will:
+ Lead complex healthcare consulting engagements, creating collaborative, high-performing environments, and ensuring successful client outcomes.
+ Manage engagement-wide economics, including budgets, revenue forecasting, margins, invoicing, and billing.
+ Apply analytical and critical thinking skills to quantify benefits, identify risks, and develop solutions for initiatives impacting a healthcare organization's contractual relationships with payers and overall reimbursement level.
+ Communicate effectively to understand client challenges, create customized solutions, manage client expectations, deliver impactful presentations and proposals.
+ Build strong executive-level relationships, lead change processes, and identify new business opportunities, leveraging Huron's capabilities to meet client objectives.
Requirements:
+ Bachelor's degree required
+ Minimum of 10 years of relevant experience, including at least 5 years of progressive healthcare management consulting experience. A combination of consulting and senior leadership roles within provider organizations may be considered, but strong healthcare consulting experience is essential.
+ Demonstrated expertise in fee-for-service payer contracting and reimbursement, including Traditional ("Original") Medicare reimbursement/payment systems, as well as with innovative payment models, negotiating complex payer reimbursement contracts for provider organizations, understanding reimbursement methodology impact on net patient service revenue, and driving revenue performance improvement for a variety of healthcare organizations. (Huron's clients range from national/regional integrated delivery systems and academic medical centers to critical access hospitals, as well as ambulatory surgery centers and single- or multi- specialty medical groups.)
+ Extensive experience in designing and contracting for value- and risk- based payments and alternative payment models, including value-based readiness assessments, care model design, ACO development (e.g., MSSP, ACO REACH, Commercial shared risks), Medicaid managed care participation. Experience with population health initiatives such as patient-centered medical homes (and other characteristics of enhanced primary care) as well as contracting vehicles (clinically integrated networks (CINs) and/or independent provider networks (IPAs))
+ Proven commitment to team development and engagement through effective coaching, talent development, and retention strategies, with a strong ability to deliver actionable, timely feedback that drives performance.
+ The ability to travel based on client, enterprise, or project needs is an essential function of this role. While travel requirements may vary based on business need, the current average travel in the Healthcare practice is less than 50%, annually.
+ Proficiency in Microsoft Office (Word, PowerPoint, Excel)
+ US Work Authorization Required
Preferences:
+ Master's degree or equivalent experience
+ Experience in a matrixed organization or cross-functional team environment
+ Exposure to clinical care delivery in a hospital and/or medical group, to understand the interplay between providing care and reimbursement
+ Experience with institutional, professional, and/or global capitation arrangements, including the contracting and economic mechanisms (i.e., division of financial responsibilities (DOFR)
The estimated base salary range for this job is $215,000 - $65,000. The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting. The actual salary paid to an individual will vary based on multiple factors, including but not limited to specific skills or certifications, years of experience, market changes, and required travel. This job is also eligible to participate in Huron's annual incentive compensation program, which reflects Huron's pay for performance philosophy. Inclusive of annual incentive compensation opportunity, the total estimated compensation range for this job is 268,750 - 350,750. The job is also eligible to participate in Huron's benefit plans which include medical, dental and vision coverage and other wellness programs. The salary range information provided is in accordance with applicable state and local laws regarding salary transparency that are currently in effect and may be implemented in the future.
**Position Level**
Senior Director
**Country**
United States of America
At Huron, we're redefining what a consulting organization can be. We go beyond advice to deliver results that last. We inherit our client's challenges as if they were our own. We help them transform for the future. We advocate. We make a difference. And we intelligently, passionately, relentlessly do great work.together.
Are you the kind of person who stands ready to jump in, roll up your sleeves and transform ideas into action? Then come discover Huron.
Whether you have years of experience or come right out of college, we invite you to explore our many opportunities. Find out how you can use your talents and develop your skills to make an impact immediately. Learn about how our culture and values provide you with the kind of environment that invites new ideas and innovation. Come see how we collaborate with each other in a culture of learning, coaching, diversity and inclusion. And hear about our unwavering commitment to make a difference in partnership with our clients, shareholders, communities and colleagues.
Huron Consulting Group offers a competitive compensation and benefits package including medical, dental, and vision coverage to employees and dependents; a 401(k) plan with a generous employer match; an employee stock purchase plan; a generous Paid Time Off policy; and paid parental leave and adoption assistance. Our Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year. All benefits and programs are subject to applicable eligibility requirements.
Huron is fully committed to providing equal employment opportunity to job applicants and employees in recruitment, hiring, employment, compensation, benefits, promotions, transfers, training, and all other terms and conditions of employment. Huron will not discriminate on the basis of age, race, color, gender, marital status, sexual orientation, gender identity, pregnancy, national origin, religion, veteran status, physical or mental disability, genetic information, creed, citizenship or any other status protected by laws or regulations in the locations where we do business. We endeavor to maintain a drug-free workplace.
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3
Senior Consultant, Healthcare Analytics - Payor/Provider Finance Data and AI, Managed Care Contra...
60684 Chicago, Illinois
Guidehouse
Posted 2 days ago
Job Viewed
Job Description
**Job Family** **:**
Data Science Consulting
**Travel Required** **:**
Up to 10%
**Clearance Required** **:**
None
**What You'll Do** :
The Healthcare Finance Data and AI team translates healthcare data into measurable healthcare financial performance. This role is dedicated to managed care contracting - you will learn to read payer contracts (commercial and government), model reimbursement terms in our existing tools, and enhance those tools with automation using SQL and Python. You will partner with contracting, revenue integrity, and patient financial services teams to ensure our modeled rates and rules align with contract language and adjudication behavior, and you will turn findings into clear, executive-ready recommendations.
+ Learn and interpret payer contracts (fee schedules, DRG/APC, per diem, percent-of-charge, case rates, carveouts, stoploss/outlier, multiple procedure reductions, modifiers, bundling/packaging rules, lesser-of logic, escalators, effective dates, term/renewal, amendments).
+ Translate contract terms into machine-readable logic and configure/model those terms in our existing pricing/adjudication tools.
+ Validate modeled results by reconciling remittance advice (835/ERA) and historical payments; investigate and resolve discrepancies with root cause analysis.
+ Maintain a controlled library of contract models (versioning, effective/expiry dates, audit trail, documentation of assumptions).
+ Build/optimize ETL/ELT pipelines to ingest fee schedules and contract artifacts; implement QA/validation checks (e.g., dimensional completeness, rate reasonableness, variance thresholds).
+ Use advanced SQL (window functions, CTEs, stored procedures, query tuning) to automate contract lookups, grouper logic, case mix normalization, and variance analytics.
+ Use Python (preferred) for parsing artifacts, applying calculation engines, regression/variance checks, and generating repeatable validation reports.
+ Develop Power BI/Tableau dashboards for contract performance (e.g., allowed vs. expected, underpayment/overpayment detection, denial patterns, yield by payer/product).
+ Own analytics workstreams; present findings that connect contract mechanics to RCM KPIs (denial rate, DNFB, AR days, first pass yield, cash acceleration, net revenue).
+ Work with Managed Care/Finance, Revenue Integrity/CDM, PFS, and IT/Data teams to align interpretation, data sources, and operationalization.
+ Support pursuits (POVs, demos) showcasing our contract modeling capabilities and automation.
+ Enhance our contract modeling tooling: propose schema/logic improvements, performance tuning, error handling, and test harnesses.
+ Contribute reusable assets (SQL/Python modules, validation checklists, samples, documentation); uphold SDLC/Agile practices and code review standards.
**What You Will Need:**
+ Bachelor's degree is required
+ Minimum THREE (3) years of experience in healthcare analytics, consulting, or adjacent healthcare services with measurable data driven outcomes (revenue cycle management exposure strongly preferred).
+ Experience building production-grade ETL/ELT processes and implementing data quality frameworks.
+ Proficiency with BI/visualization tools (Power BI or Tableau) and strong Excel skills.
+ Excellent communication-able to translate technical and contractual details into concise, executive-ready insights.
+ Detail oriented, self-directed, collaborative teammate comfortable leading workstreams.
**What Would Be Nice To Have** **:**
+ Hands‑on with Azure Data Factory, Databricks, SSIS (or similar).
+ Understanding of payer/provider operations and payment methodologies; experience with contract modeling or payment variance analytics is a strong plus (we will train on contract reading).
+ Experience with Agile practices and Git-based version control.
+ Experience with regulatory reporting and transparency initiatives (e.g., CMS price transparency, charge master reviews).
The annual salary range for this position is $102,000.00-$170,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
**What We Offer** **:**
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
+ Medical, Rx, Dental & Vision Insurance
+ Personal and Family Sick Time & Company Paid Holidays
+ Position may be eligible for a discretionary variable incentive bonus
+ Parental Leave and Adoption Assistance
+ 401(k) Retirement Plan
+ Basic Life & Supplemental Life
+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
+ Short-Term & Long-Term Disability
+ Student Loan PayDown
+ Tuition Reimbursement, Personal Development & Learning Opportunities
+ Skills Development & Certifications
+ Employee Referral Program
+ Corporate Sponsored Events & Community Outreach
+ Emergency Back-Up Childcare Program
+ Mobility Stipend
**About Guidehouse**
Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse's Ethics Hotline. If you want to check the validity of correspondence you have received, please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant's dealings with unauthorized third parties.
_Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee._
Data Science Consulting
**Travel Required** **:**
Up to 10%
**Clearance Required** **:**
None
**What You'll Do** :
The Healthcare Finance Data and AI team translates healthcare data into measurable healthcare financial performance. This role is dedicated to managed care contracting - you will learn to read payer contracts (commercial and government), model reimbursement terms in our existing tools, and enhance those tools with automation using SQL and Python. You will partner with contracting, revenue integrity, and patient financial services teams to ensure our modeled rates and rules align with contract language and adjudication behavior, and you will turn findings into clear, executive-ready recommendations.
+ Learn and interpret payer contracts (fee schedules, DRG/APC, per diem, percent-of-charge, case rates, carveouts, stoploss/outlier, multiple procedure reductions, modifiers, bundling/packaging rules, lesser-of logic, escalators, effective dates, term/renewal, amendments).
+ Translate contract terms into machine-readable logic and configure/model those terms in our existing pricing/adjudication tools.
+ Validate modeled results by reconciling remittance advice (835/ERA) and historical payments; investigate and resolve discrepancies with root cause analysis.
+ Maintain a controlled library of contract models (versioning, effective/expiry dates, audit trail, documentation of assumptions).
+ Build/optimize ETL/ELT pipelines to ingest fee schedules and contract artifacts; implement QA/validation checks (e.g., dimensional completeness, rate reasonableness, variance thresholds).
+ Use advanced SQL (window functions, CTEs, stored procedures, query tuning) to automate contract lookups, grouper logic, case mix normalization, and variance analytics.
+ Use Python (preferred) for parsing artifacts, applying calculation engines, regression/variance checks, and generating repeatable validation reports.
+ Develop Power BI/Tableau dashboards for contract performance (e.g., allowed vs. expected, underpayment/overpayment detection, denial patterns, yield by payer/product).
+ Own analytics workstreams; present findings that connect contract mechanics to RCM KPIs (denial rate, DNFB, AR days, first pass yield, cash acceleration, net revenue).
+ Work with Managed Care/Finance, Revenue Integrity/CDM, PFS, and IT/Data teams to align interpretation, data sources, and operationalization.
+ Support pursuits (POVs, demos) showcasing our contract modeling capabilities and automation.
+ Enhance our contract modeling tooling: propose schema/logic improvements, performance tuning, error handling, and test harnesses.
+ Contribute reusable assets (SQL/Python modules, validation checklists, samples, documentation); uphold SDLC/Agile practices and code review standards.
**What You Will Need:**
+ Bachelor's degree is required
+ Minimum THREE (3) years of experience in healthcare analytics, consulting, or adjacent healthcare services with measurable data driven outcomes (revenue cycle management exposure strongly preferred).
+ Experience building production-grade ETL/ELT processes and implementing data quality frameworks.
+ Proficiency with BI/visualization tools (Power BI or Tableau) and strong Excel skills.
+ Excellent communication-able to translate technical and contractual details into concise, executive-ready insights.
+ Detail oriented, self-directed, collaborative teammate comfortable leading workstreams.
**What Would Be Nice To Have** **:**
+ Hands‑on with Azure Data Factory, Databricks, SSIS (or similar).
+ Understanding of payer/provider operations and payment methodologies; experience with contract modeling or payment variance analytics is a strong plus (we will train on contract reading).
+ Experience with Agile practices and Git-based version control.
+ Experience with regulatory reporting and transparency initiatives (e.g., CMS price transparency, charge master reviews).
The annual salary range for this position is $102,000.00-$170,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
**What We Offer** **:**
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
+ Medical, Rx, Dental & Vision Insurance
+ Personal and Family Sick Time & Company Paid Holidays
+ Position may be eligible for a discretionary variable incentive bonus
+ Parental Leave and Adoption Assistance
+ 401(k) Retirement Plan
+ Basic Life & Supplemental Life
+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
+ Short-Term & Long-Term Disability
+ Student Loan PayDown
+ Tuition Reimbursement, Personal Development & Learning Opportunities
+ Skills Development & Certifications
+ Employee Referral Program
+ Corporate Sponsored Events & Community Outreach
+ Emergency Back-Up Childcare Program
+ Mobility Stipend
**About Guidehouse**
Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse's Ethics Hotline. If you want to check the validity of correspondence you have received, please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant's dealings with unauthorized third parties.
_Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee._
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View Now
4
Claim Counsel, Managed Care and Healthcare
60515 Downers Grove, Illinois
Travelers Insurance Company
Posted 2 days ago
Job Viewed
Job Description
**Who Are We?**
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim, Legal
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$111,600.00 - $184,200.00
**Target Openings**
1
**What Is the Opportunity?**
Bond & Specialty Insurance (BSI) provides management and professional liability, cyber, crime insurance, and surety bonds to or on behalf of businesses of all sizes. The BSI Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to optimize claim results. Travelers' PNP Programs Team provides coverage for Community Associations, Healthcare Institutions and Providers, Managed Care Organizations, Life and Health Underwriters and Public Adjusters. As a valued member of our team, in addition to claim, you also will provide legal advice to our underwriting colleagues and non-attorney claim colleagues, and participate in BSI claim strategic initiatives.
**What Will You Do?**
+ Follow operational policies to analyze, investigate, and resolve BSI claims of varying levels of severity with moderate supervision from claims management.
+ Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.
+ Retain, monitor, and manage outside counsel actively utilizing litigation management plans and budgets.
+ Communicate with underwriting on significant claim exposures.
+ Continue to develop the ability to identify all recovery opportunities and coordinate recovery efforts with the Recovery Management Unit and Claim management.
+ Travel to and attend mediations, settlement conferences, claim conferences, field office visits, trials and depositions.
+ Refine policy interpretation/coverage analysis skills including drafting coverage opinions with case law included.
+ Strengthen the ability to negotiate settlements/resolutions, review releases and settlement agreements, including confidentiality and non-disclosure provisions.
+ Support underwriting marketing efforts, including participation in broker and account visits and risk mitigation seminars and authoring customer-focused white papers and articles.
+ Monitor marketplace conditions, conduct research, and draft reference materials to inform claim and underwriting colleagues on law impacting Travelers' underwriting and claim decisions.
+ Obtain and maintain required adjusters' licenses.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Five or more years of relevant legal or claim handling work experience.
+ Demonstrated ability to effectively work through conflict and resolve issues with a professional demeanor.
+ Ability to make sound decisions and negotiate terms and conditions within designated authority limit.
+ Strong verbal and written communication skills with the ability to clearly articulate coverage determinations.
+ Time management skills with the ability to manage multiple priorities with an attention to detail, data and analytics.
+ Ability to build and maintain effective and collaborative relationships with colleagues, customers, and business partners.
**What is a Must Have?**
+ Bachelor's Degree.
+ Juris Doctorate Degree.
+ Properly licensed, registered or authorized, and in good standing, to practice law in the jurisdiction in which you will be working.
+ Two years of relevant legal experience.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ( ) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit .
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim, Legal
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$111,600.00 - $184,200.00
**Target Openings**
1
**What Is the Opportunity?**
Bond & Specialty Insurance (BSI) provides management and professional liability, cyber, crime insurance, and surety bonds to or on behalf of businesses of all sizes. The BSI Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to optimize claim results. Travelers' PNP Programs Team provides coverage for Community Associations, Healthcare Institutions and Providers, Managed Care Organizations, Life and Health Underwriters and Public Adjusters. As a valued member of our team, in addition to claim, you also will provide legal advice to our underwriting colleagues and non-attorney claim colleagues, and participate in BSI claim strategic initiatives.
**What Will You Do?**
+ Follow operational policies to analyze, investigate, and resolve BSI claims of varying levels of severity with moderate supervision from claims management.
+ Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.
+ Retain, monitor, and manage outside counsel actively utilizing litigation management plans and budgets.
+ Communicate with underwriting on significant claim exposures.
+ Continue to develop the ability to identify all recovery opportunities and coordinate recovery efforts with the Recovery Management Unit and Claim management.
+ Travel to and attend mediations, settlement conferences, claim conferences, field office visits, trials and depositions.
+ Refine policy interpretation/coverage analysis skills including drafting coverage opinions with case law included.
+ Strengthen the ability to negotiate settlements/resolutions, review releases and settlement agreements, including confidentiality and non-disclosure provisions.
+ Support underwriting marketing efforts, including participation in broker and account visits and risk mitigation seminars and authoring customer-focused white papers and articles.
+ Monitor marketplace conditions, conduct research, and draft reference materials to inform claim and underwriting colleagues on law impacting Travelers' underwriting and claim decisions.
+ Obtain and maintain required adjusters' licenses.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Five or more years of relevant legal or claim handling work experience.
+ Demonstrated ability to effectively work through conflict and resolve issues with a professional demeanor.
+ Ability to make sound decisions and negotiate terms and conditions within designated authority limit.
+ Strong verbal and written communication skills with the ability to clearly articulate coverage determinations.
+ Time management skills with the ability to manage multiple priorities with an attention to detail, data and analytics.
+ Ability to build and maintain effective and collaborative relationships with colleagues, customers, and business partners.
**What is a Must Have?**
+ Bachelor's Degree.
+ Juris Doctorate Degree.
+ Properly licensed, registered or authorized, and in good standing, to practice law in the jurisdiction in which you will be working.
+ Two years of relevant legal experience.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ( ) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit .
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