Experience supporting supplemental insurance claims or appeals reviews
Experience reviewing operative reports, medical charts, Explanation of Benefits documents, UB-04 forms, or Health Care Financing Administration (HCFA) claim forms
Experience preparing audit workpapers and traceable evidence for quality control, compliance, or regulatory review
Experience developing or delivering training on medical documentation, coding updates, or appeals procedures
Experience working across distributed delivery teams in the United States and India
The successful candidate would possess these skills
Ability to work independently and collaborate as part of a team
Effective written and verbal communication skills
Meticulous attention to detail and quality of work product
Ability to build and sustain professional relationships
Ability to lead projects or workstreams
Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
Strong interpersonal skills and professional demeanor
Ability to meet deadlines
Ability to provide clear guidance to others
Information for applicants with a need for accommodation: https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html
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Additional Information
Position Summary
Senior Consultant, Health Insurance - Risk Regulatory & Compliance
Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organizations. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation.
Work You'll Do
As a Senior Consultant on our Insurance and Life Sciences team, you will:
Review medical records, claims documentation, and benefit materials to support accurate determinations for procedures, treatments, confinements, and applicable benefits
Conduct appeals reviews for denied or underpaid claims, assess documentation, coding, and policy interpretation issues, and prepare clear review rationales supported by evidence
Apply medical coding standards and claims artifacts, including International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), UB-04, Health Care Financing Administration (HCFA) claim forms, and Explanation of Benefits documents
Execute quality control and audit activities, identify root causes, recommend corrective actions, and support process improvements that increase accuracy, consistency, and compliance
Develop training materials, share medical documentation and coding guidance with team members, and collaborate across United States and United States India teams to meet client expectations and service level agreements
The Team
Our Regulatory & Financial Risk offering supports clients' regulatory and compliance needs, balancing risk and regulatory requirements with enhancing business value and optimizing outcomes. We deliver enhanced value through strategic transformation, end-to-end implementation, and a focus on business-as-usual sustainability across processes, controls, and data & analytic infrastructures.
Required Qualifications
Bachelor's degree in Health Information Management, Healthcare Administration or a related field
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
8+ years of experience in the United States health care or health insurance industry, including claims review, claims appeals, medical billing and coding, utilization management, or payment integrity
Experience applying International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) in claims, medical record, or appeals reviews
Ability to work business hours aligned to the Eastern Time Zone
Ability to travel 50%, on average, based on the work you do and the clients and industries/sectors you serve.
Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.
Deloitte · Boston, MA