Overview
Engagement Type: Remote High-priority, immediate start
Start Timeline: ASAP (Target onboarding: Early-July)
We are seeking a highly experienced Healthcare Claims Integration Consultant to support a strategic healthcare initiative focused on dual claims processing, payer integration, and cost optimization in collaboration with Aetna and related healthcare programs.
This role is critical to supporting a large-scale healthcare transformation involving Medicare and Medicaid coordination, dual claims strategy, and payer operational alignment.
The consultant will work closely with executive leadership (CIO/President level stakeholders) to design and implement a scalable approach for claims integration and cost efficiency.
Key Responsibilities
- Lead design and advisory for dual claims strategy and integration frameworks
- Support healthcare payer alignment involving Aetna, Medicare, and Medicaid
- Analyze and optimize claims workflows, coordination of benefits (COB), and adjudication processes
- Define and recommend operating models for cost reduction and claims efficiency
- Collaborate with executive stakeholders to translate business needs into technical and operational solutions
- Evaluate current-state claims processes and identify gaps, risks, and integration opportunities
- Provide advisory support for payer integration during acquisition or organizational transition
- Guide implementation strategy for claims data exchange and interoperability
- Support development of roadmaps, governance models, and execution plans
Required Experience
- 10+ years in healthcare payer/claims domain
- Strong expertise in claims processing, adjudication, and payer operations
- Hands-on experience with dual claims / coordination of benefits (COB)
- Exposure to Medicare and Medicaid programs and regulatory frameworks
- Experience working with or alongside Aetna or similar large national payers
- Strong understanding of healthcare cost structures and reimbursement models
- Experience in payer integration, healthcare transformation, or acquisition support
- Ability to engage with CIO, VP, and executive-level stakeholders
Preferred Experience
- Healthcare consulting background (Big 4 or boutique healthcare advisory)
- Experience with claims platforms, payer systems, or healthcare data integration
- Familiarity with EDI transactions (837/835), HIPAA compliance
- Experience in large-scale payer modernization programs
Soft Skills
- Strong executive communication and stakeholder management
- Strategic thinking with ability to operate in ambiguous environments
- Ability to bridge business, clinical, and technical teams
- Problem-solving mindset with focus on measurable cost impact
Ideal Candidate Profile
A senior healthcare domain expert who has:
- Designed or led claims integration or dual claims programs
- Worked with large payer ecosystems (Aetna strongly preferred)
- Delivered cost optimization and operational transformation in healthcare claims environments
About the Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid) Opportunity
Progressive Computer Solutions is currently hiring for a Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid) position based in Remote. This is a contractor opportunity suited to candidates who are ready to contribute their skills and grow within a dynamic team environment. Whether you're an experienced professional or looking to take the next step in your career, this role offers a chance to work on meaningful projects while developing new capabilities.
What the Role Involves
As a Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid), you will be expected to collaborate closely with cross-functional teams, take ownership of key deliverables, and contribute ideas that help Progressive Computer Solutions achieve its goals. Day-to-day responsibilities typically include planning and prioritizing tasks, communicating progress with stakeholders, maintaining high standards of quality, and adapting to evolving business needs. The exact scope of duties may vary depending on team structure and current priorities, so candidates should be comfortable with a role that can evolve over time.
Who Progressive Computer Solutions is Looking For
Successful candidates generally bring a combination of relevant experience, strong communication skills, and a proactive attitude toward problem-solving. Progressive Computer Solutions values individuals who can work independently as well as part of a team, who are detail-oriented, and who bring a positive, adaptable mindset to their work. Prior experience in a similar Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid) capacity is beneficial, though a strong willingness to learn and grow is equally important.
Compensation and Benefits
Compensation for this role is competitive and commensurate with experience. In addition to base pay, many roles at Progressive Computer Solutions may include benefits such as health coverage, paid time off, opportunities for professional development, and a supportive work culture designed to help employees thrive both personally and professionally.
Why Join Progressive Computer Solutions?
Joining Progressive Computer Solutions as a Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid) means becoming part of a team that values collaboration, innovation, and continuous improvement. Employees are encouraged to bring their own perspective to the table, and the organization aims to foster an environment where people feel supported in doing their best work. This is a great opportunity for candidates who want their contributions to have a real, visible impact.
How to Apply
If you believe you're a strong fit for the Healthcare Claims Integration Consultant (Dual Claims Aetna / Medicare / Medicaid) role at Progressive Computer Solutions in Remote, we encourage you to review the full job details above and submit your application through the listed channel. This position was posted on 2026-06-23T18:53:24.000Z and applications are being accepted through 2026-07-25T19:50:45.000Z. Early applications are generally encouraged, as competitive roles like this one can attract a high volume of interest.
