Manager, Solution Specialist,Payment Intelligence

Manager, Solution Specialist, Payment Intelligence

AArete is one-of-a-kind when it comes to consulting firm culture.

We're a global, innovative management and technology consulting firm, with offices in the U.S., India, and the U.K. Our name comes from the Greek word for excellence: "Arete." And excellence is exactly what we strive for.

Our success starts with enriching and empowering our people. From robust career development planning to competitive life and wellness benefits, AArete's "Culture of Care" takes a holistic approach to the employee experience.

AAretians (our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing space for personal development and fulfillment.

The Role

Health plans face continued challenges in reimbursing claims on time and accurately. AArete's consulting service line, Payment Intelligence , goes beyond typical payment integrity to ensure erroneous and inefficient payments are identified, rectified, and recouped to prevent them in the future.

In this role, the individual will lead client engagements focused on claims analytics, overpayment identification, and post-pay data mining strategies. The Manager will oversee a team of analysts and consultants to design and implement solutions that improve claims payment accuracy and operational efficiency. This role will report to a Payment Intelligence Director and will play a key role in supporting internal capability development, client relationship management, and the growth of AArete's Payment Intelligence practice.

Work You'll Do

• Lead day-to-day delivery activities across multiple projects, ensuring work quality, timeliness, and alignment with client expectations

• Guide the design, development, and validation of data-driven analyses to identify payment inaccuracies, process inefficiencies, and potential recoveries

• Translate analytical findings into actionable insights and strategic recommendations for senior client stakeholders

• Direct and manage team members in claims analytics, policy interpretation, and process improvement

• Develop project plans, timelines, and deliverables while managing competing priorities across project teams and clients

• Oversee automation and tool-based initiatives that enhance claims review accuracy and operational scalability

• Support business development activities including proposal writing, project scoping, and client presentations

• Maintain awareness of regulatory changes, emerging trends, and market dynamics impacting payment integrity

• Exercise strong communication, leadership, and client-facing presence across all engagements

• Other duties as assigned

Requirements

• 7+ years of experience in payment integrity, healthcare analytics, or payer operations with a Bachelor's Degree, or 10+ years of equivalent experience without a degree

• Comprehensive understanding of healthcare claims and reimbursement methodologies across Medicare, Medicaid, ACA/Marketplace, Commercial, and Duals

• Demonstrated experience managing analytics or consulting teams delivering payment integrity or cost containment solutions

• Proficiency in claims data analytics and identification of mispaid claims to ensure accuracy and compliance

• Familiarity with spend categories (professional, ancillary, outpatient, inpatient), modifiers, and place of service codes

• Knowledge of industry tools related to claims editing, provider data, and contract management

• Strong communication, presentation, and stakeholder management skills

• Advanced proficiency in Microsoft Excel or working knowledge of SQL or other query languages

• Strong analytical, problem-solving, and storytelling abilities to translate complex data into actionable recommendations

• Knowledge of the healthcare, benefits, and insurance industries, as well as managed care delivery systems

• Passion for excellence and desire to help differentiate AArete in the market

• Capability and interest to grow into larger, more strategic leadership role over time

• Must be legally authorized to work in the United States without the need for employer sponsorship

Preferred Requirements

• Policy & Claims Editing Expertise

• Research and interpretation of healthcare policies and regulations

• Experience in reimbursement policy writing and claims editing

• Proficiency in data mining to detect errors and inconsistencies

• Ability to crosswalk and compare edits and policies

• Knowledge of claims editing processes, including Prepay/Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record Reviews

• Contract Configuration & Provider Data Expertise

• Interpretation of provider contract terms and pricing methodologies, including fee schedules, per diem, DRGs, cost-plus, and outlier payments

• Understanding of contract carve-outs, including bundled services, readmissions, and reductions

• Experience in contract pricing and claims reimbursement analysis

• Ability to price and reprice claims based on contractual agreements

• Understanding of provider TIN and NPI relationships

• Familiarity with network processes, including Optimization, Adequacy, and Pricing

• Familiarity with claims adjudication systems (e.g., Facets, QNXT, Amisys, etc.)

• Based in Chicago, IL, and flexible to work from our Chicago office as needed

Compensation & Benefits

• Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays

• Own Your Day flexible work policy

• Competitive majority employer-paid benefits: Medical, Dental, Vision, 401K Match

• Generous paid parental leave options

• Employer paid Life Insurance, STD, LTD

• Charitable contribution matching program

• New client commission opportunities and referral bonus program

• Bike share discount program

The estimated base salary range for this position is $125,000 - $165,000. In addition to this base salary, individuals may be eligible for an annual discretionary bonus. This range is a part of a competitive, total compensation package together with our majority employer-paid benefits, and incentive pay for eligible roles. Please note that this range is a guideline and individual total compensation may vary due to numerous factors including but not limited to experience level, certifications, and other relevant business considerations.

AArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available.

We put humans at the center of our work

We're a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results.

But what sets us apart is our people. We are guided by our deeply embedded guiding principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion.

And we've been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine.

We've earned a Great Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault's Top 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000's Fastest Growing Firms, and Consulting Magazine's Fastest Growing Firms.

Learn more about our award-winning culture

We are an Equal Employment Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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