Principal Healthcare Consultant, Claims Principal Healthcare Consultant, Claims …

West Monroe Partners
in Dallas, TX, United States
Permanent, Full time
Be the first to apply
West Monroe Partners
in Dallas, TX, United States
Permanent, Full time
Be the first to apply
Principal Healthcare Consultant, Claims

Principal Healthcare Consultant, Claims

1722 Routh Street, Suite 850
Dallas, Texas, 75201
United States

At West Monroe, our people are our business. 

 We pride ourselves on bringing a different mindset to consulting—and that takes a different approach: highly collaborative, flexible, and tenacious.

Our people-first, highly collaborative culture is core to our identity. It’s something we care about, and something we strive to enrich and preserve. No hierarchies. No siloes. No egos. Just smart ideas, unique perspectives, and the drive to make an impact for our clients.

We also know that the best outcomes for both our people and our clients result from including diverse perspectives at the table. That’s why inclusion & diversity is one of our core values. 

Every day our clients rely on us to help them tackle their greatest challenges, by strategically deploying technology through a business-focused and industry-specific lens. We bring together both the right knowledge and the right approach, so that they can capitalize on opportunities and deliver real results. That takes the right team. And that’s where you come in.

Ready for the next step on your career journey? 

West Monroe is hiring a Principal with prior industry or consulting leadership management, project delivery, and systems implementation / assessment experience with deep subject matter expertise to join our Healthcare and Life Sciences practice. Our team assists payers, providers, and pharmaceutical companies in uncovering opportunities, developing clear roadmaps, and working toward improved outcomes. We depend on our highly skilled consultants to drive growth – in our clients’ companies and in their own careers.

What will you be doing?

Client Delivery:

  • Communicate and report project status to C-level executives and internal West Monroe project managers including delivery progress, risks, issues, and dependencies
  • Understand underlying relevant technology platforms and business processes to be able to direct and provide thought leadership to drive system assessment, custom design, development, testing, and implementation of a Core Administrative Processing Solutions (CAPS) (such as HealthRules Payor, Facets, QNXT, Javelina, Tapestry or others)
  • Provide expertise and best practices to clients for specific functional and/or technical areas of focus related to core administrative platforms. Example focus areas include (but are not limited to):
    • Client Installation, Enrollment and Eligibility Processing 
    • Premium Billing and Administrative Services Only Policy Funding 
    • Benefit Configuration, Pricing, Operations Workflows, 
    • Claims, Payments, Encounter, Clinical Edit Processing
    • Provider Data Management and Network Configuration
    • Platform Configuration, Coordination, Customization and Integration
  • Quickly respond to client requests for immediate issues while also being able to drive projects to completion
  • On larger engagements, be able to work across various management teams and determine inter-dependencies between the WMP project and other initiatives
  • Provide subject matter expertise across multiple, concurrent engagements, ensuring full-time delivery team can craft deliverables based on guidance provided
  • Review project deliverables for completeness and appropriateness
  • Proactively identify risks and develop mitigation plans based on past experiences

Practice Development:

  • Participate actively in the recruiting process for other consultants
  • Drive the development/enhancement of the core administration platform assessment and implementation methodologies and approaches for client delivery
  • Coach and manage other consultants by providing professional guidance and sharing subject matter expertise relevant to client/project scope
  • Develop next generation of subject matter experts / leaders with a specific focus on claim platform knowledge sharing
  • Refine delivery methodologies and develop delivery tools/accelerators based on subject matter expertise

Business Development:

  • Understand business needs and requirements and help turn those goals into concrete projects and detailed proposals
  • Create work plans, pricing estimates, and risk assessments for prospects
  • Actively build a professional network and affiliate network in the local community
  • Contribute to revenue generation and solution offerings ideas through expertise; help execute business development campaigns
  • Build credibility with existing and prospective clients during the proposal process
  • Create subject matter eminence through social media sharing, speaking engagements, industry panel participation
  • Participate in key client relationships and growing those accounts
  • Play an influencer role in the industry by providing valuable insight and thought leadership based on expertise and experience in Core Administrative Processing Solutions or in the medical claims processing industry

What do you need to bring to the table?

  • Bachelor’s degree or equivalent experience required
  • Prior industry or consulting project leadership experience
  • 10+ years of hands-on experience as a functional or technical leader driving business operation, technology projects and/or large scale software implementation projects
  • Deep subject matter expertise with three or more claims-specific systems, including but not limited to: Facets, HealthRules Payor, QNXT, Javelina, Epic Tapestry, or other CAPS
  • Knowledge and experience with complex business systems integration and technology transformation
  • Industry experience with benefit configuration, regulatory rules or claims adjudication
  • Experience working in a fast-paced, collaborative, and team-based project environment
  • Ability to lead and mentor other team members or developers while leading projects
  • Excellent leadership, organizational, verbal and written communication skills to communicate technical concepts to non-technical business stakeholders
  • Ability to travel 60%+
  • A commitment to inclusion and diversity, and openness to new ideas and perspectives 
  • Familiarity with custom design and development, database design, and data management preferred 

Ready to get started? Join our team and make an impact.  

To learn more about inclusion and diversity at West Monroe, visit

West Monroe Partners is an Equal Employment Opportunity Employer 
We believe in treating each employee and applicant for employment fairly and with dignity. We base our employment decisions on merit, experience, and potential, without regard to race, color, national origin, sex, sexual orientation, gender identity, marital status, age, religion, disability, veteran status, or any other characteristic prohibited by federal, state or local law.

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