medical cost consultant

AAA Life Insurance Company

<div>
 
 Overview
 
 
 
 AAA Life is a respected and trusted American brand that has been focusing on Life Insurance and Annuity Products since 1969. At AAA Life we have over 1.8 million policies where we take pride in earning the trust of our policyholders who understand our promise to be there for them &ndash; and their families &ndash; when we&rsquo;re needed most. By joining the AAA Life team, you are joining a company that genuinely cares about helping each other, with a devotion to protect the lives of those around us. We embrace a diverse, equitable, inclusive culture where all associates can feel a sense of belonging and use their unique talents and perspective to influence, innovate, motivate, and thrive.
 
 
 The Medical Claims Consultant is responsible for providing medical and business expertise and knowledge in support of claims decisions. This role&rsquo;s primary responsibility is to serve as a resource to the claims team including contestable claims examiners, Accident and Health examiners, claims consultants and management with respect to denials, appeals, escalations or complex medical questions that arise in the processing of claims.
 
 
 
 Responsibilities
 
 
 
 
 How You&rsquo;ll Work
 
 
 
 Work Solution: Hybrid
 
 
 Relocation Eligibility: Not Available
 
 
 <ul>
 <li>
 Serve as a resource to the contestable claims team. This includes review of contestable claims as needed by claims personnel.
 </li>
 <li>
 Review of medical documentation including physician and hospital records, accident reports or other clinical materials
 </li>
 <li>
 Review and understanding of policy language &ndash; interpret policy exclusions and endorsements in relation to medical findings
 </li>
 <li>
 Review all contestable claim denials, including those that may have potential to result in litigation
 </li>
 <li>
 Identify inconsistencies or gaps in medical documentation and recommend additional information when needed.
 </li>
 <li>
 Serve as a resource to claims consultants and management with regards to denials, appeals or escalations that involve medical decisions
 </li>
 <li>
 Resource to the entire claims team with respect to complex medical decisions that arise in the day-to-day handling of claims. Assist in determining whether a claim is eligible under policy language and with respect to any supporting medical documentation.
 </li>
 <li>
 Provide training for claims examiners on medical topics relevant to claims decision making
 </li>
 <li>
 Support claim work related to denials or appeals that require medical decision making
 </li>
 <li>
 Participate in training and round tables, providing medical expertise in support of claims decision making.
 </li>
 <li>
 Collaborates closely with claims examiners, underwriters, legal counsel and potentially third parties to ensure accurate and fair claims decisions
 </li>
 <li>
 Maintain up-to-date knowledge of relevant medical standards, diagnostic/treatment guidelines, and regulatory/industry developments that impact claim adjudication
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Doctorate or Advanced healthcare degree (MD, DO, BA-PA (Physician Assistant Bachelor&rsquo;s Degree in conjunction with PA certification, PA-C, NP, RN) with demonstrated claim-consulting or clinical review experience
 </li>
 <li>
 Clinical experience (min 5-10 years) with a strong familiarity of a broad range of medical conditions, treatments or outcomes
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Experience in the life insurance industry
 </li>
 <li>
 Excellent ability to interpret and synthesize complex medical records, and to translate findings into actionable claims decisions.
 
 
 </li>
 </ul>
 While performing the duties of this job, the employee is frequently required to stand, walk, sit, use hands to finger, handle, or feel, talk, hear and concentrate. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.
 
 
 This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodation will be made for otherwise qualified applicants as needed to enable them to fulfill these requirements.
 
 
 We are committed to ensuring equal employment opportunities for all job applicants and employees. Employment decisions are based upon job-related reasons regardless of an applicant's race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, marital status, genetic information, protected veteran status, or any other status protected by law.
 
 
 
 AAA Life Insurance Company does not offer immigration sponsorship for this position. This includes visa types such as H-1B, TN, and STEM OPT. Please do not apply if you currently require or may require employer-sponsored immigration support now or in the future.
 
 
 
 PM21
 
 
</div>

Medical Claims Consultant- Part Time

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary 
As a Medical Economics Manager, you will develop and maintain recurring and ad hoc reports to support the needs of internal and external customers, including regulatory and compliance needs, as well as network support. An ability to comprehend complex report requirements, summarize available data to meet those requirements and maintain documentation will be key. The role will include access to the Enterprise Data Warehouse and the use of various tools and platforms including GCP and Python.
Key Responsibilities:<ul><li>
Collaborate with cross-functional teams to develop and maintain reports and resources required by internal and external constituencies.</li><li>
Review complex reporting requirements and apply the requirements to available data in the EDW and elsewhere.</li><li>
Review existing reports to look for opportunities to increase efficiency and improve accuracy.</li><li>
Utilize SQL and other available tools to create ad hoc reports as needed.</li><li>
Monitor deadlines to finish projects accurately and on time. Keep leadership and requesters apprised of risks.</li><li>
Work constructively with team members to achieve common goals.</li></ul> 
Required Qualifications:
<ul><li>5+ years of experience in healthcare or finance reporting.
</li><li>Proven proficiency in MS Office with advanced proficiency in Excel.</li><li>
Proven proficiency using SQL to query large relational databases.</li><li>
Proven analytical skills with experience using data to report cost and utilization patterns.</li></ul>
Preferred Qualifications:<ul><li>
5+ years of experience in an analytical role in the healthcare industry.</li><li>
Experience using BigQuery and other GCP tools.</li><li>
Experience using Python to move and analyze data.</li><li>
Experience reporting healthcare utilization, as well as an understanding of common formulas used in healthcare analytics.</li></ul> 
Education
BS/BA in Finance, Economics, Math, Healthcare Administration or another STEM field or equivalent relevant experience is required.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,300.00 - $145,860.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 04/20/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Medical Economics Consultant

Search 10000+ Medical cost consultant jobs near you this April. New roles added regularly across leading industries. Apply today.

10000 medical cost consultant jobs Near Me

Medical Claims Consultant- Part Time

Medical Economics Consultant

Medical Economics Consultant

Medical Economics Consultant

Medical Economics Consultant

Medical Economics Consultant

Medical Economics Consultant