Manager
Your experience counts!
- MBA from Tier-1 B-Schools OR a postgraduate degree with rich experience of working in US healthcare consulting domain and/or payer/provider cost optimization and clinical innovation initiatives will be a good fit as well
- 7-12 years of relevant experience
- End-to-end understanding of payer and/or provider functional value chain components with focus on transformation engagements aligned to data-driven consulting (exposure to data analysis tools and claims/UM data), digital care/clinical ops enablement and related themes
- Prior experience of working with US healthcare companies preferable or must have worked across engagements with US healthcare clients
- Exposure to Data Strategy and GenAI for Health Use Cases
Should have project experience in any 3-5:
- Clinical process assessment/redesign
- Clinical cost reduction strategy
- Acute/chronic care management
- Wellness and disease management programs; accreditations like NCQA
- Intelligent utilization management
- Connected care and digital health products
- Clinical value use case development, benefit assessment and implementation
- Healthcare data sets, EMR/EHR and exposure to analytics tools and techniques
- Exposure to Data Strategy and GenAI for Health Use Cases
Should have project experience in working around (any 3-5):
- Payer Sales Operations (Quote to Card)
- Payer Sales Strategy and Marketing
- Health Insurance Product Design / Benefit Design
- CPQ (Configure-Pricing-Quoting) processes
- Health Insurance Exchanges
- Stakeholder experience design - Broker/Shopping/Member/Provider Portals
- Digital Front Door - Members/Patients
- CRM Processes and Platforms
- Contact Centers / A&G / Member Retention and Loyalty
- Capability/Process experience in SF Vlocity, SFMC, Highroads, Simplify products would be an added advantage
- Consulting knowledge of Analytics/AI/IoT in Customer Experience area would be a plus.
Should have project experience in working around (any 3-5):
- Claims Adjudication & Reimbursement
- Member Enrollment
- Benefits Administration
- Utilization Management
- Claims Audit & Reporting
- Medicare Part C, Part D Knowledge
- Payments & Billing
- Products / Platforms - Facets, QNXT, HealthEdge, RxClaims
- Provider contracting & network management
- Regulatory Compliance - STARS, HEDIS measures
- Member /Provider Communication