Job Summary

As a Claims Lead, you will work with US healthcare payer clients to identify opportunities that reduce medical and administrative costs, improve payment accuracy, and strengthen operational performance. You will help clients understand business issues, dig into the data, and develop recommendations that can be put into action. We are looking for someone who is comfortable going deep on unfamiliar payer topics, knows how to research quickly and thoughtfully, and can connect the dots across claims, operations, reimbursement, and client priorities.

Work You'll Do

- Research payer topics, industry trends, regulations, operating models, and client-specific business issues.

- Review and analyze medical, pharmacy, eligibility, provider, pricing, reimbursement, and other healthcare data to find trends, issues, and opportunities.

- Use SQL and other tools to work through large datasets and evaluate utilization, cost drivers, reimbursement patterns, payment accuracy, and operational performance.

- Check data quality, test assumptions, document the logic behind the analysis, and make sure the work can stand up to client review.

- Develop recommendations, business cases, and implementation plans tied to cost savings, process improvement, medical cost management, and operational efficiency.

- Build practical points of view on payer topics such as claims, provider networks, reimbursement, payment integrity, utilization management, prior authorization, medical management, member experience, risk adjustment, Stars/quality, value-based care, and payer operations.

- Take loosely defined problems and turn them into a clear workplan by identifying the right questions, data sources, research sources, and decision points.

- Create presentations, summaries, dashboards, and reports that clearly explain what the analysis shows and what actions the client should consider.





- Lead workstreams, manage day-to-day analysis, and coordinate with client stakeholders, vendors, and internal AArete teams.

- Explain technical findings in plain business language during client meetings and internal working sessions.

- Coach Analysts, Interns, and global support teams by assigning work, reviewing outputs, and helping the team deliver better work faster.

- Identify related client needs and bring them to leadership when additional AArete support may be useful.

- Bring sound judgment, ownership, curiosity, and a hands-on problem-solving mindset to each engagement.

- Other duties as assigned

Requirements

- 10+ years of experience in healthcare analytics, payer operations, claims analytics, healthcare operations, or a similar client-facing role.

- Bachelor's degree required, or equivalent experience.

- Strong understanding of healthcare claims data, health plan data, payer processes, provider data, reimbursement concepts, and claims data structures.

- Positive SQL skills and experience working with large datasets.

Experience with Snowflake, Excel, or similar tools is helpful.

- Advanced Excel and PowerPoint skills, with the ability to create clean, client-ready analysis and presentations.

- Experience with BI tools such as Power BI or Tableau, including dashboards, reports, or recurring analytics outputs.

- Strong analytical skills and the ability to move from data to insights, recommendations, and business cases.

- Excellent research skills, including the ability to learn unfamiliar payer topics, evaluate sources, pull out what matters, and explain the business implications clearly.

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 Claims Lead (Pune)
🏢 aarete
📍 Pune