Consultant I, Medicare Claims Data Analyst

Avalere Health is seeking a Consultant to join its Commercialization and Regulatory Strategy group.

Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, DC, the firm delivers actionable insights, business intelligence tools, and custom analytics for leaders in healthcare business and policy. Avalere’s experts span 200 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO, and the Congress), top consultancies, and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. As an Inovalon company (Nasdaq: INOV), Avalere’s focus on strategy is supported by outstanding data analytics that generate unique insights and meaningful business improvement. Through events, publications, and interactive programs, Avalere insights are accessible to a broad range of customers.

The Commercialization and Regulatory Strategy practice focuses on a wide range of areas, such as coverage, coding, and payment across commercial and public payers; pricing and contracting; and patient support services. We assess how our clients’ products fit within the emerging coverage and reimbursement landscape and help our clients optimize market access for their products though deep subject matter expertise and understanding of their business issues.


  • Developing new models and analytic approaches to provide insights on value and market access
  • Advising healthcare industry stakeholders using data-driven analysis
  • Extracting and using both public (e.g., Medicare Public Use Files) and private (e.g., Avalere proprietary claims and pharmacy event) claims from databases to create analytic, predictive, or assumption-driven assessments of medical products within various existing and de novo incentive sets
  • Working independently and on collaborative teams with other analysts and experts, sometimes as the lead quantitative analyst on the project
  • Interpreting others’ analyses to assess, critique, or build on their findings
  • Understanding analyses and insights of other entities (e.g., CMS, MEDPAC, ICER, client proprietary Data on File)
  • Presenting quantitative results to both technical and non-technical audiences, in formats such as Excel, PowerPoint, and written memorandum
  • Directing interaction with clients and other stakeholders, either in person or via teleconference or email
  • Maintaining compliance with Inovalon’s policies, procedures and mission statement
  • Adhering to all confidentiality and HIPAA requirements as outlined within Inovalon’s operating policies and procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position
  • Fulfilling those responsibilities and duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the company
  • Upholding responsibilities relative to the separation of duties for applicable processes and procedures within your job function

We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

Skills, Experience, and Other Job-Related Requirements

Education Requirements

  • A graduate degree in biological sciences, pharmacy, public policy, public health, economics, biostatistics, epidemiology, health services research, or related field, or an undergraduate degree in the areas above and related work experience

Skill Requirements

  • Familiarity with key data sources for healthcare analysis (e.g., Medicare Claims, Medicare Part D data, commercial claims data, Medicare Public Use File data, Medicare Current Beneficiary Survey data)
  • A strong interest in and knowledge of commercial, Medicare, and Medicaid payment systems (i.e., some subset of inpatient hospital, outpatient hospital, pharmacy, physician office, Medicare Part B vs D, or other payment setting/schedule)
  • Knowledge of existing claims and coding systems such as CPT, HCPCS, NDC, and ICD-10
  • Strong understanding of current US healthcare payment dynamics such as rebating, gross-to-net, value-based contracting, and formulary design
  • The ability to understand commercial or government payer payment models and create or edit existing models to determine financial or volume effects of changes to these incentive systems
  • Demonstrated analytic and quantitative skills
  • Excellent written and oral communication skills
  • A willingness to learn complex issues relating to the health care delivery system
  • Initiative, working independently with minimal supervision
  • Ability to work in teams
  • A positive, professional, and solution-oriented attitude

Experience Requirements

  • 4–6 years of relevant full-time work experience
  • Experience with healthcare-related quantitative analysis (e.g., pricing and contracting models, alternative payment models, claims-based analysis)
  • Solid experience using SQL to manipulate large data sets
  • Experience with one or more programming languages (e.g., SAS, Stata, SPSS, R, SQL, Python)
  • Experience in managing multiple deadlines
  • Advanced experience with the Microsoft Office Suite, in particular Excel and Access; SAS/Stata experience strongly preferred, with opportunities to strengthen and develop skills
  • Preference for prior experience at 1 or more of the following: pharmaceutical or medical device pricing and contracting, commercial payer (insurer or PBM), specialty pharmacy, health system, CMS, OMB, or similar
  • Prior experience with peer-reviewed publication preferred
*Avalere is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.