Top 40 Claims consultant Jobs in Vallejo Ca

Medical Informatics Analyst, Consultant
Blue Shield of California —Oakland, CA
- $123,090 - $184,800 a year
- Full-time
- Hybrid work
- Background check
- 5 years
- Pass drug screening
- Work from home
Senior Data Science Consultant, Insurance - Remote
CSAA Insurance Services, Inc. —Walnut Creek, CA
- $160,155 - $213,550 a year
- Full-time
- 7 years
- US work authorization
- Experience equivalent to degree accepted
- 401(k) matching
12d
Digital Product Manager, Consultant
Blue Shield of California —Oakland, CA
- $123,090 - $184,800 a year
- Full-time
- Hybrid work
- Background check
- 6 years
- Pass drug screening
- Work from home
IT Product Manager, Consultant
Blue Shield of California —Oakland, CA
- $123,090 - $184,800 a year
- Full-time
- Hybrid work
- Background check
- Azure
- Pass drug screening
- Work from home
Benefits Consultant
Alliant Insurance Services —Walnut Creek, CA
- $190,000 - $210,000 a year
- Email
- Bachelor's degree
- Experience equivalent to degree accepted
- Senior level
Quick Apply
Property & Casualty Insurance Claims Operations Consultant, Manager
PRICE WATERHOUSE COOPERS —San Francisco, CA
- $99,000 - $232,000 a year
- Mid-level
- Finance
- Bachelor's degree
- Paid holidays
- Health insurance
Financial Consultant
Gallagher Benefit Services —Walnut Creek, CA
- $70,000 - $136,500 a year
- Mid-level
- Windows
- Analysis skills
12d
Collision Consultant
OEConnection —San Francisco, CA
- Hybrid work
- Marketing
- 3 years
- Driver's License
- Paid holidays
- Health insurance
7d
Payer Analytics Consultant (Defined Term)
Central California Alliance for Health —San Francisco, CA
- Email
- Hybrid work
- Microsoft Outlook
- Research
- Mid-level
- Wellness program
- Paid holidays
Quick Apply
Senior Economic Damages Consultant
J.S. Held LLC —San Francisco, CA
- $110,000 - $140,000 a year
- Full-time
- Hybrid work
- Microsoft Word
- 3 years
- Finance
- Commuter assistance
- Health insurance
Quick Apply
Data Engineer, Consultant (Hybrid)
Releady —San Francisco, CA
- $75 - $85 an hour
- Full-time
- Hybrid work
- 7 years
- SQL
- Bachelor's degree
Quick Apply
6d
Payer Back Office Strategy / Technology / Operations Consultant, Manager
PRICE WATERHOUSE COOPERS —San Francisco, CA
- $99,000 - $232,000 a year
- 5 years
- Master's degree
- Bachelor's degree
- Paid holidays
- Health insurance
Group Employee Benefits Consulting Manager
Accenture —Walnut Creek, CA
- $87,400 - $293,800 a year
- Full-time
- 3 years
- Bachelor's degree
- Product management
- Paid holidays
- Disability insurance
Health - Network Performance / Utilization Manager
Accenture —Walnut Creek, CA
- $87,400 - $293,800 a year
- Full-time
- Bachelor's degree
- Travel
- US work authorization
- Paid holidays
- Disability insurance
Life Insurance Consulting Manager
Accenture —Walnut Creek, CA
- $87,400 - $293,800 a year
- Full-time
- 3 years
- Product management
- Travel
- Paid holidays
- Disability insurance
Managing Director, Expert Services
Kroll —San Francisco, CA
- $200,000 - $500,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
10d
P&C Insurance (Personal & Commercial) Transformation Manager
Accenture —Walnut Creek, CA
- $87,400 - $293,800 a year
- Full-time
- Up to 50% travel
- 5 years
- Bachelor's degree
- Paid holidays
- Disability insurance
Senior Director - Voluntary Benefits Consultant
WTW —San Francisco, CA
- $160,000 - $200,000 a year
- Full-time
- 6 years
- Bachelor's degree
- Travel
- Paid jury duty
- Health savings account
Employer Health and Welfare Senior Consultant, Strategy, Growth, and Transformation
Deloitte —San Francisco, CA
- $137,700 - $229,500 a year
- Full-time
- Bachelor's degree
- Team management
- Travel
Consulting Actuary - Technology Risk
Lockton, Inc. —San Francisco, CA
- $130,000 - $155,000 a year
- Full-time
- Research
- Office
- Finance
- Paid training
- Wellness program

I want to receive the latest job alert for claims consultant in vallejo ca

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

claims consultant jobs near vallejo ca

Data Consultant jobs in San Francisco, CA

Data Scientist jobs in Walnut Creek, CA

Economic Consultant jobs in San Francisco, CA

Medical Consultant jobs in Oakland, CA

Managing Director jobs in San Francisco, CA

IT Analyst jobs in Oakland, CA

Financial Consultant jobs in Walnut Creek, CA

Employee Benefits Account Manager jobs in Walnut Creek, CA

Data Consultant jobs in New York, NY

Healthcare Consultant jobs in San Diego, CA

Data Consultant jobs in Seattle, WA

Entry Level Consultant jobs in New York, NY

Data Consultant jobs in Fairview Heights, IL

Data Entry jobs in Winston Salem, NC

Leasing Consultant jobs in San Diego, CA

Data Consultant jobs in Minneapolis, MN

Health Insurance Remote jobs in Wisconsin

Nurse Consultant jobs in Austin, TX

Insurance Consultant jobs in Hartford, CT

Insurance Consultant jobs in Nashville, TN

Medical Informatics Analyst, Consultant

Blue Shield of California -
Oakland, CA

Apply Now

Job Details

Full-time
$123,090 - $184,800 a year

Benefits

Work from home

Qualifications

Pegasystems
Data Integration (Data management)
Medicare
Cloud data warehouses
Automation
SAS
Managed care organization experience
Data structures
CMS
SAS language
SQL
Data Architecture Design (Architecture design skills)
Salesforce Cloud
Math
Health insurance knowledge
Cloud Native Design
CRM system proficiency
AI-driven automation
Healthcare IT
Technical Proficiency
Python
Statistical analysis tools
Database software proficiency

Full Job Description

Your Role

The AI & Analytics (AI&A) team sits within the enterprise Growth organization, specifically aligned to the Risk Adjustment vertical. While situated within the Risk adjustment, this is strictly an advanced Medical Informatics and data architecture role. The Consultant will serve as a critical semantic bridge and analytical lead supporting multiple Government Lines of Business (LOBs) within Senior Markets with a distinct focus on Special Needs Plans (SNPs).

Reporting to the Sr Manager of Medical Informatics, this role is responsible for acting as an AI & Analytics partner to key leaders and cross-functional stakeholders across Medicare, Med Supp, Actuarial, and Finance to achieve their Growth-related business objectives. The successful candidate will act as "two-in-a-box" collaborator to share LOB Membership Retention & Growth goals, translate complex business problems into structured analytical approaches, design smart analytical tools, and leverage internal data structures

Your Work

In this role, you will:

Use deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
Design and develop these systems so that they can be used by lower-level analysts thereby promoting company-wide efficiencies
Lead the architectural transition of legacy, on-premise analytic workflows and data pipelines into modern, cloud-native environments, utilizing Databricks, Snowflake, and other enterprise-governed cloud tools to ensure scalable, automated business logic.
Coordinate activities with other internal departments to maximize overall efficiency and resolve conflicts
Communicate project status, progress, and outcomes to executive management
Fulfill a leadership role in the critical review and ongoing development of data management and analytical systems for strategically important enterprise-wide analysis and reporting
Serve as a technical mentor by reviewing SQL, SAS, and Python code of junior staff while working independently to drive complex portfolios forward with limited supervision. Integrate AI-assisted development tools (such as GitHub Copilot) into daily coding workflows to accelerate deployment timelines, enhance code quality, and support automated pre-peer-review safety nets. Be adept at creating new reusable assets
Lead complex medical claims analysis to support Cost of Health Care (CoHC) analytics, dissecting trends, cost drivers, and billing methodologies to identify optimization and recover opportunities
Improve member retention & conversion rates by collaborating with business partners to design and report from outreach tracking systems (e.g., PEGA, Salesforce) and conduct plan cost/value studies.
Improve Acquisition by leveraging data from Markets, Provider, Geo, and Operations tracking to target and execute strategies that drive multi-product growth as customers transition through different life stages
Ability to identify drivers of membership both internally and externally, as well as conversions from one product to another as customers transition through different life stages

Your Knowledge and Experience

Requires a college degree or equivalent experience. Master’s degree preferred
Requires a minimum 7 years of prior relevant experience with 5+ years advanced experience working with complex Medical Claims, Membership and Provider data architectures.
Requires a minimum of 5 years’ experience in Health Care (managed care, academic, or gov't payer),
Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
Requires advanced coding proficiency in SQL & SAS, with strong applied experience in Python and a working knowledge of modern cloud-native data stacks (Snowflake, Databricks, RDBMS etc.) for pipeline automation.
Requires familiarity with AI coding assistants (e.g. GitHub Copilot, Codex) or a strong, demonstrated willingness to quickly learn and adopt AI tooling to optimize engineering efficiency
Requires fluency with Senior Markets lines of business (MAPD, DSNP, Medicare Supplement, Medi-Cal) and CMS MARx regulatory data structures (MMR, DTRR, BEQ, etc.)
Requires high degree of fluency with PEGA, Salesforce and similar enterprise CRM/outreach applications
Requires proficiency in interpersonal communication, verbal/written presentations, math, analytical problem-solving, and the ability to adapt quickly to shifting or competing priorities

ABOUT THE TEAM
About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Apply Now

Refine Your Search

claims consultant jobs in vallejo ca

Medical Informatics Analyst, Consultant

Senior Data Science Consultant, Insurance - Remote

Digital Product Manager, Consultant

IT Product Manager, Consultant

Benefits Consultant

Property & Casualty Insurance Claims Operations Consultant, Manager

Financial Consultant

Collision Consultant

Payer Analytics Consultant (Defined Term)

Senior Economic Damages Consultant

Data Engineer, Consultant (Hybrid)

Payer Back Office Strategy / Technology / Operations Consultant, Manager

Group Employee Benefits Consulting Manager

Health - Network Performance / Utilization Manager

Life Insurance Consulting Manager

Managing Director, Expert Services

P&C Insurance (Personal & Commercial) Transformation Manager

Senior Director - Voluntary Benefits Consultant

Employer Health and Welfare Senior Consultant, Strategy, Growth, and Transformation

Consulting Actuary - Technology Risk

I want to receive the latest job alert for claims consultant in vallejo ca

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected