Manager - Healthcare Consulting - US Market

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