Base Career helps you apply smarter for this job.
Key skills for this role
We are seeking a Clinical Coding & Claims Analytics Consultant with experience in clinical coding, medical claims analysis, reimbursement methodologies, and healthcare consulting. The role will support the development of clinical rules for claims adjudication, conduct coding and reimbursement analytics, contribute to DRG and grouper initiatives, and deliver consulting projects for healthcare payers, providers, and health system stakeholders.
The ideal candidate should possess strong knowledge of clinical coding systems, health insurance operations, claims adjudication workflows, reimbursement frameworks, and healthcare data analytics, with exposure to healthcare markets across the Middle East.
Independent for over 75 years, Milliman delivers market-leading services and solutions to clients worldwide. Today, we are helping companies take on some of the world’s most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics and business transformation. Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance, and financial services, and property and casualty insurance.
We are seeking a Clinical Coding & Claims Analytics Consultant with experience in clinical coding, medical claims analysis, reimbursement methodologies, and healthcare consulting. The role will support the development of clinical rules for claims adjudication, conduct coding and reimbursement analytics, contribute to DRG and grouper initiatives, and deliver consulting projects for healthcare payers, providers, and health system stakeholders.
The ideal candidate should possess strong knowledge of clinical coding systems, health insurance operations, claims adjudication workflows, reimbursement frameworks, and healthcare data analytics, with exposure to healthcare markets across the Middle East.
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
, USA
, USA
Indianapolis, USA
Wakefield, USA
Brookfield, USA
, USA
, USA
, USA
Indianapolis, USA
Wakefield, USA
Seattle, USA
Brookfield, USA
, USA
Support the design, development, testing, and validation of clinical rules used in medical claims adjudication and payment integrity programs.
Define clinical logic for medical necessity review, coding validation, reimbursement controls, benefit interpretation, and claims editing.
Participate in user acceptance testing (UAT) and validation of clinical rule engines and adjudication systems.
Perform clinical coding reviews and code mapping across healthcare coding and classification systems - ICD-10-AM, ACHI, SBS and ADRG / AR-DRG
Ensure coding consistency and compliance with applicable coding standards, reimbursement guidelines, and payer policies.
Support coding validation exercises, reimbursement reviews, and clinical classification projects.
Analyze structured and unstructured medical claims data to identify coding discrepancies, billing anomalies, utilization patterns, and reimbursement opportunities.
Support payment integrity initiatives through identification of inappropriate billing, coding errors, duplicate claims, and reimbursement leakage.
Contribute to DRG grouper validation, fee schedule development, reimbursement modelling, and healthcare costing initiatives.
Support consulting projects related to:
Clinical code mapping
Claims audits
Claims analytics
DRG implementation
Develop analytical reports, presentations, client deliverables, and documentation.
Participate in stakeholder discussions and support project execution across multiple workstreams.
Conduct healthcare data quality assessments and identify opportunities for process improvement.
Interpret payer policies, reimbursement guidelines, and regulatory requirements relevant to claims adjudication and coding practices.
Generate actionable insights from claims and clinical data to support decision-making and operational improvements.
Clinical Coding & Classification
Claims Adjudication & Payment Integrity
Healthcare Reimbursement
DRG & Grouper Analytics
Claims Data Analysis
Data Quality Assessment
Analytical Thinking & Problem Solving
Documentation & Communication
Independent actuarial and consulting firm serving insurers, healthcare organizations, governments, and employers worldwide.
Visit company websiteJobs and hiring trendsFull-time
Mid · 2+ years experience
Onsite
Apply faster on company sites with our extension.