Job
Description
" Healthcare,Consulting,Business Process ","description":" Roles & Responsibilities: Design operational and technology blueprints to enhance healthcare payer core administration capabilities. Provide cross-functional consulting on core admin platform strategy, implementation, and process optimization. Build business cases focused on cost savings , performance improvement, and reduction in Total Cost of Ownership (TCO). Apply industry and geography-specific regulatory knowledge to inform decision-making and ensure compliance. Deliver insights on market\/industry trends , competitive product landscapes, and customer business domains. Advise on COTS products and vendor selection strategies; guide implementation types such as upgrades, conversions, and migrations. Use frameworks like BPM, Value Stream Mapping , and process harmonization to assess and improve business processes. Lead requirement gathering and analysis efforts, creating artifacts such as blueprints, workflows, and functional specs. Support governance and maintain quality through project management tools, estimation techniques, and metrics. Collaborate with client and internal stakeholders to structure solutions using UST offerings and domain-specific COTS tools. Guide the use of project governance frameworks, RACI matrix , and effective knowledge management practices. Understand pricing\/licensing models and contribute to developing proposals and delivery models. Must-Have Skills: Strong domain knowledge in Healthcare Payer operations and core administration platforms . Proven experience in process consulting, BPM , and business transformation in a healthcare context. Working knowledge of COTS healthcare products and their implementation life cycle (e.g., Facets, QNXT, HealthRules). Expertise in requirement elicitation, process mapping, and documentation standards . Familiarity with project management practices including scoping, risk management, estimation, and delivery metrics. Strong communication and stakeholder management skills; ability to liaise between technical and business teams. Understanding of industry regulations and compliance (HIPAA, NCQA, CMS). Good-to-Have Skills: Exposure to competitive product landscapes and emerging technologies in healthcare platforms. Knowledge of pricing\/licensing models and advanced commercial models (e.g., outcome-based pricing). Familiarity with tools such as Visio, MPP, JIRA , and knowledge management platforms (wikis, portals). Experience working with consulting frameworks , vendor evaluation processes, and client engagements. Background in estimation models like UCP, FP, and resource planning techniques. ","
