Domain Expert - HealthCare

We are seeking a highly skilled and experienced SME in US Healthcare Payer and Provider Data and Analytics space. You will work closely on Payer and Provider solutions to design, implement, and optimize value-based care analytics, Population health, utilization management, member engagement, clinical and claims analytics leveraging data management, analytics, AI / ML, and GenAI to improve outcomes, reduce costs, and enhance patient experiences.

Key Responsibilities :

Value-Based Care Strategy & Implementation

Champion data and analytics solution offerings across value-based care, care management, member engagement, clinical and claims analytics.

Advise payers and providers on operational analytics, population health, utilization management, and care coordination to enable VBC success.

Data-Driven Insights & Performance Optimization

Collaborate with data engineering and analytics teams to design dashboards and AI-driven predictive models for patient stratification, readmission prevention, and cost optimization.

Shape next-gen solutions leveraging Agentic AI for clinical decision support, prior authorization, claims adjudication, and RCM workflows.

Provide strategic guidance on integrating EHR, claims, and SDoH data to deliver measurable improvements in quality and cost outcomes.

Stakeholder Engagement & Advisory

Drive requirement discussions, solution strategy, scope and approach to evangelize the solutions development with technical team.

Support sales and business development teams by providing subject matter expertise in client discussions, RFP responses, and solution demonstrations.

Regulatory Compliance & Market Trends

Stay updated on healthcare policies, CMS regulations, and emerging VBC trends to ensure clients remain compliant and competitive.

Conduct industry research and contribute to whitepapers, webinars, and client education sessions on value-based care strategies.

Required Skills and Experience :

Domain Expertise

Deep understanding of value-based care models, population health management, and risk-based payment arrangements.

Experience with payer-provider integrations, data and analytics modernization requirements to drive customer use cases

Technical & Analytical Proficiency

Knowledge of healthcare data sources, including claims, EHR, Labs, HIEs, and SDoH.

Experience with data analytics, AI / ML in healthcare, and performance measurement tools (e.g., Power BI, Tableau, Databricks, Azure, AWS).

Communication & Leadership Skills

Strong ability to engage with executive-level stakeholders and translate complex VBC concepts into actionable strategies.

Excellent presentation and writing skills for client engagements, proposals, and thought leadership.

Industry Experience

8-10 years of experience in healthcare consulting, payer or provider organizations, or health tech firms focusing on value-based care.

Experience in crafting solution offerings, detailing requirements, scope and coming up with right messaging and value proposition

Preferred Qualifications :

Bacheleor’s or Master’s degree in Engineering, Business, Data Science or related field.

Certifications in value-based care, population health, or healthcare analytics (e.g., CHIE, CPHIMS).

Experience working with health systems, ACOs, or payers on VBC program implementations.