23 Payer Jobs

Hi, Greetings! This is regarding a job opportunity for the position of Data Modeller with a US based MNC in Healthcare Domain. This opportunity is under the direct pay roll of US based MNC. Job Location: Pune, Mundhwa Mode of work: Hybrid (3 days work from office) Shift timings: 1pm to 10pm About the Company: The Global MNC is a mission-driven startup transforming the healthcare payer industry. Our secure, cloud-enabled platform empowers health insurers to unlock siloed data, improve patient outcomes, and reduce healthcare costs. Since our founding in 2017, we've raised over $81 million from top-tier VCs and built a thriving SaaS business. Join us in shaping the future of healthcare data. With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payers access to data that has been historically siloed and inaccessible. As a result, these payers can ingest and manage all the information they need to transform their business by supporting their analytical, operational, and financial needs through our platform. Since our founding in 2017, it has built a highly successful SaaS business, raising more than $80 Million by leading VC firms with profound expertise in the healthcare and technology industries. We are solving massive complex problems in an industry ready for disruption. We're building powerful momentum and would love for you to be a part of it! Interview process: 5 rounds of interview 4 rounds of Technical Interview 1 round of HR or Fitment discussion Job Description: Data Modeller About the Role: Were seeking a Data Modeler to join our global data modeling team. Youll play a key role in translating business requirements into conceptual and logical data models that support both operational and analytical use cases. This is a high-impact opportunity to work with cutting-edge technologies and contribute to the evolution of healthcare data platforms. What Youll Do Design and build conceptual and logical data models aligned with enterprise architecture and healthcare standards. Perform data profiling and apply data integrity principles using SQL. Collaborate with cross-functional teams to ensure models meet client and business needs. Use tools like Erwin, ER/Studio, DBT, or similar for enterprise data modeling. Maintain metadata, business glossaries, and data dictionaries. Support client implementation teams with data model expertise. What Were Looking For 2+ years of experience in data modeling and cloud-based data engineering. Proficiency in enterprise data modeling tools (Erwin, ER/Studio, DBSchema). Experience with Databricks, Snowflake, and data lakehouse architectures. Strong SQL skills and familiarity with schema evolution and data versioning. Deep understanding of healthcare data domains (Claims, Enrollment, Provider, FHIR, HL7, etc.). Excellent collaboration and communication skills. In case you have query, please feel free to contact me on the below mention email or whatsapp or call. Thanks & Regards, Priyanka Das Email: priyanka.das@dctinc.com Contact Number: 74399 37568

Title/Designation : Product Consultant/ Payer Integration Lead/Architect Role : Payer Core Solutioning Location : Navi Mumbai/ Pune/ Bangalore/ Chennai/ Gurgaon/ Hyderabad Work Mode: Hybrid Exp: 12 to 15 years Role & responsibilities: Candidate will be part of our Payer consulting team, responsible for working with clients on implementing key solutions, work closely with client account leads in identifying new transformational opportunities with accounts and develop proactive proposals thereby contributing to overall account growth and client success Actively participate in client presentations, proposal walkthroughs, demos to convey CitiusTech solution & value proposition Work with customer delivery and field teams and educating on roadmaps and delivery. Single handedly drive & own the sales support process in coordination with Sales / Account Management leads, Delivery leads, other Architects Provide consulting and domain thought leadership to customers, company and teams Preferred candidate profile: 12 - 15 years experience in any one or more sub-sectors of Healthcare such as Payers i.e. Health Insurance preferably in the US market as Healthcare Consultant. More than 10 years hands-on experience on TriZettos platforms (either Facets or QNXT) or any other leading US claims platforms in a Technical Architect / Lead / role Deep knowledge of core payer processes incl. member enrolment, provider, claims, authorizations, payments, contact center etc. Design and architect robust integration solutions encompassing data flows, APIs, message routing, transformation, orchestration, and infrastructure considerations Deep understanding of integration patterns, architectures, and technologies, including ESB, message brokers, data integration tools, APIs, and web services. Experience developing efficiency tools incl. accelerators, best practices, automation scripts etc. Navigate complexities and ambiguities with client ask or industry trend to clearly document & present CitiusTech solution & expertise Ability to understand the client problem statement and strong analytical skills for identifying the possible solution Ability to build professional relationships, a spirit of co-operation, and a flexible approach to work are required Experience in defining themes, epics, stories for requirements, experience of working in Agile Scrum Experience of working in cloud and hybrid environments incl. use of cloud-native services, containerization, CI/CD pipelines Good understanding of SDLC process and experience working with development teams to ensure successful delivery of solutions Self-motivated and strong team player Ability to work in a fast paced, entrepreneurial environment Strong verbal and written communication skills Travel Expected travel: Short term to US to meet customers and internal planning and discussions, as and when required (Post Covid) Travel within India as required for project work or internal meetings

Title/Designation : Product Consultant/Architect Role : Customer Success - Payer Core Solutioning Location : Navi Mumbai/ Pune/ Bangalore/ Chennai/ Gurgaon/ Hyderabad Work Mode: Hybrid Exp: 12 to 15 years Role & responsibilities: Candidate will be part of our Payer consulting team, responsible for working with clients on implementing key solutions, work closely with client account leads in identifying new transformational opportunities with accounts and develop proactive proposals thereby contributing to overall account growth and client success Actively participate in client presentations, proposal walkthroughs, demos to convey CitiusTech solution & value proposition Work with customer delivery and field teams and educating on roadmaps and delivery. Single handedly drive & own the sales support process in coordination with Sales / Account Management leads, Delivery leads, other Architects Provide consulting and domain thought leadership to customers, company and teams Preferred candidate profile: 12 - 15 years experience in any one or more sub-sectors of Healthcare such as Payers i.e. Health Insurance preferably in the US market as Healthcare Consultant. More than 10 years hands-on experience on TriZettos platforms (either Facets or QNXT) or any other leading US claims platforms in a Technical Architect / Lead / role Deep knowledge of core payer processes incl. member enrolment, provider, claims, authorizations, payments, contact center etc. Design and architect robust integration solutions encompassing data flows, APIs, message routing, transformation, orchestration, and infrastructure considerations Deep understanding of integration patterns, architectures, and technologies, including ESB, message brokers, data integration tools, APIs, and web services. Experience developing efficiency tools incl. accelerators, best practices, automation scripts etc. Navigate complexities and ambiguities with client ask or industry trend to clearly document & present CitiusTech solution & expertise Ability to understand the client problem statement and strong analytical skills for identifying the possible solution Ability to build professional relationships, a spirit of co-operation, and a flexible approach to work are required Experience in defining themes, epics, stories for requirements, experience of working in Agile Scrum Experience of working in cloud and hybrid environments incl. use of cloud-native services, containerization, CI/CD pipelines Good understanding of SDLC process and experience working with development teams to ensure successful delivery of solutions Self-motivated and strong team player Ability to work in a fast paced, entrepreneurial environment Strong verbal and written communication skills Travel Expected travel: Short term to US to meet customers and internal planning and discussions, as and when required (Post Covid) Travel within India as required for project work or internal meetings

Title/Designation : Sr. Payer Integration Lead / Architect Role : Customer Success - Payer Core Solutioning Location : Navi Mumbai/ Pune/ Bangalore/ Chennai/ Gurgaon/ Hyderabad Work Mode: Hybrid Exp: 12 to 15 years Role & responsibilities: Candidate will be part of our Payer consulting team, responsible for working with clients on implementing key solutions, work closely with client account leads in identifying new transformational opportunities with accounts and develop proactive proposals thereby contributing to overall account growth and client success Actively participate in client presentations, proposal walkthroughs, demos to convey CitiusTech solution & value proposition Work with customer delivery and field teams and educating on roadmaps and delivery. Single handedly drive & own the sales support process in coordination with Sales / Account Management leads, Delivery leads, other Architects Provide consulting and domain thought leadership to customers, company and teams Preferred candidate profile: 12 - 15 years experience in any one or more sub-sectors of Healthcare such as Payers i.e. Health Insurance preferably in the US market as Healthcare Consultant. More than 10 years hands-on experience on TriZettos platforms (either Facets or QNXT) or any other leading US claims platforms in a Technical Architect / Lead / role Deep knowledge of core payer processes incl. member enrolment, provider, claims, authorizations, payments, contact center etc. Design and architect robust integration solutions encompassing data flows, APIs, message routing, transformation, orchestration, and infrastructure considerations Deep understanding of integration patterns, architectures, and technologies, including ESB, message brokers, data integration tools, APIs, and web services. Experience developing efficiency tools incl. accelerators, best practices, automation scripts etc. Navigate complexities and ambiguities with client ask or industry trend to clearly document & present CitiusTech solution & expertise Ability to understand the client problem statement and strong analytical skills for identifying the possible solution Ability to build professional relationships, a spirit of co-operation, and a flexible approach to work are required Experience in defining themes, epics, stories for requirements, experience of working in Agile Scrum Experience of working in cloud and hybrid environments incl. use of cloud-native services, containerization, CI/CD pipelines Good understanding of SDLC process and experience working with development teams to ensure successful delivery of solutions Self-motivated and strong team player Ability to work in a fast paced, entrepreneurial environment Strong verbal and written communication skills Travel Expected travel: Short term to US to meet customers and internal planning and discussions, as and when required (Post Covid) Travel within India as required for project work or internal meetings

Gainwell Technologies LLC Summary As a Sr Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas. Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact Work with the client to develop business specs at the start of a technical project Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals Help verify that all requirements have been met by approving and validating test results Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work What we're looking for Business Analyst Summary Assists in the research and assessment of business goals, objectives and needs to align information technology solutions with business initiatives for multiple, less complex accounts. Serves as the liaison between technical personnel and business area for multiple accounts. Basic Qualifications 8+ years of experience in Business Analyst, Claims adjudication, Medicaid or Medicare, SQL. 8+ years of business functional experience in one or more areas such as Eligibility, Claims. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Basic Qualifications 8+ years of experience in Business Analyst, Claims adjudication, Medicaid or Medicare, SQL. 8+ years of business functional experience in one or more areas such as Eligibility, Claims. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements.

Gainwell Technologies LLC Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are the key player in the Medicaid space with a presence in 51 of the 56 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), Fiscal Agent Services, Program Integrity, Care Management, Immunization Registry, and Eligibility Services. We generate over $2 billion in annual revenue, and we’ve been innovating in the industry for more than 50 years. Powered by more than 14,000 employees, Gainwell solutions support more than 60 million Medicaid beneficiaries nationwide and manage 1 billion encounters annually. Additionally, about 1.5 billion immunization records are maintained, and we serve more than 3 million providers annually. We do this while saving our state and commercial clients ~5.5 billion dollars annually in cost avoidance. Our commitment to clients drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology. In summary, there’s no company better positioned in the Medicaid and HHS (Health and Human Services) market than Gainwell. For more information on Gainwell, visit www.gainwelltechnologies.com Summary Essential Job Functions Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities. Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates. Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design. Assists in developing and modifying systems requirements documentation to meet client needs. Participates in meetings with clients to gather and document requirements and explore potential solutions. Executes systems tests from existing test plans. Assists in analyzing test results in various phases. Participates in technical reviews and inspections to verify 'intent of change' is carried through phase of project. What we're looking for Business Analyst Summary Assists in the research and assessment of business goals, objectives and needs to align information technology solutions with business initiatives for multiple, less complex accounts. Serves as the liaison between technical personnel and business area for multiple accounts. Basic Qualifications 3+ years of experience in Business Analyst, Claims adjudication, Medicaid or Medicare, SQL. 3+ years of business functional experience in one or more areas such as Eligibility, Claims. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Req-30055 Business Analyst (Medicaid) - Claims

Gainwell Technologies LLC Summary Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are the key player in the Medicaid space with a presence in 51 of the 56 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), Fiscal Agent Services, Program Integrity, Care Management, Immunization Registry, and Eligibility Services. We generate over $2 billion in annual revenue, and we’ve been innovating in the industry for more than 50 years. Powered by more than 14,000 employees, Gainwell solutions support more than 60 million Medicaid beneficiaries nationwide and manage 1 billion encounters annually. Additionally, about 1.5 billion immunization records are maintained, and we serve more than 3 million providers annually. We do this while saving our state and commercial clients ~5.5 billion dollars annually in cost avoidance. Our commitment to clients drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology. In summary, there’s no company better positioned in the Medicaid and HHS (Health and Human Services) market than Gainwell. For more information on Gainwell, visit www.gainwelltechnologies.com Your role in our mission Essential Job Functions Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities. Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates. Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design. Assists in developing and modifying systems requirements documentation to meet client needs. Participates in meetings with clients to gather and document requirements and explore potential solutions. Executes systems tests from existing test plans. Assists in analyzing test results in various phases. Participates in technical reviews and inspections to verify 'intent of change' is carried through phase of project. What we're looking for Basic Qualifications 3+ years of experience in Business Analyst, Provider, Claims adjudication, Medicaid or Medicare, SQL. 3+ years of business functional experience in one or more areas such as Eligibility, Claims, Provider. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Business Analyst Professional (US Healthcare / Medicaid) - Provider

Gainwell Technologies LLC Summary As a Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas. Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact Work with the client to develop business specs at the start of a technical project Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals Help verify that all requirements have been met by approving and validating test results Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work What we're looking for Business Analyst Summary Assists in the research and assessment of business goals, objectives and needs to align information technology solutions with business initiatives for multiple, less complex accounts. Serves as the liaison between technical personnel and business area for multiple accounts. Basic Qualifications 8+ years of experience in Business Analyst, Provider, Claims adjudication, Medicaid or Medicare, SQL. 8+ years of business functional experience in one or more areas such as Eligibility, Claims, Provider. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Req-29890 Business Analyst (US Healthcare / Medicaid) - Provider

Dear Aspirants, Greeting from Sagility!! Immediate hiring for AM-Process Training in Bangalore-Work from office Job description: Role and Responsibilities The resource would be part of a dynamic team. Would be working with the other members of the training, operations and the quality teams to manage conduct of new hire training, while also being responsible for the quality performance of the newly trained resources by planning and executing various interventions during the on the job training phase. An approximate list of responsibilities is appended below (but not limited to): Should have experience working in Claims, PB, PDM & Credentialing Managing attrition and ensuring the batch throughput is as per the business targets and maintain healthy first pass yield (as per defined targets) Managing batch productivity & batch quality till the 90 days post classroom training Establishing and leading a review cadence, create performance benchmarks to measure and report to management Managing & working with clients, internal teams to drive content updation, effectiveness and availability Identifying and managing stakeholders by establishing requirements, performance reviews, collating feedback and drafting improvement plans where necessary Investing a substantial amount of time into self & team/ people development, by way of upskilling, cross skilling and formalized individual development plans Initiating or being a part of major improvement initiatives towards betterment of training practices, measurement and overall process improvement Leading a team of trainers & master trainers towards achieving laid down team goals & objectives Responsible for driving constant content review, analysis and improvements where necessary Implementing cost control through optimization of resources such as trainer availability, batch handover timelines, return on investment etc. Qualifications and Education Requirements Any graduate can apply for this position, however, should have a minimum of 5 years of U.S. Healthcare experience either in the Payor or Provider line of business, in a similar position (with people management being a key KRA). Two Way Cab will be provided. Interested candidates can share their profile to below mentioned mail ID. anitha.c@sagilityhealth.com Thanks & Regards, TA Team Sagility

Key Responsibilities: A day in the life of an Infoscion As part of the Infosys delivery team your primary role would be to interface with the client for quality assurance issue resolution and ensuring high customer satisfaction You will understand requirements create and review designs validate the architecture and ensure high levels of service offerings to clients in the technology domain You will participate in project estimation provide inputs for solution delivery conduct technical risk planning perform code reviews and unit test plan reviews You will lead and guide your teams towards developing optimized high quality code deliverables continual knowledge management and adherence to the organizational guidelines and processes You would be a key contributor to building efficient programs systems and if you think you fit right in to help our clients navigate their next in their digital transformation journey this is the place for you If you think you fit right in to help our clients navigate their next in their digital transformation journey this is the place for you Technical Requirements: Primary skills Technology DevOps DevOps Architecture Consultancy Technology Finacle Core Payments Positive Pay Services Advance Technology Infrastructure Mainframes Security Technology OpenSystem Python OpenSystem Additional Responsibilities: Knowledge of more than one technology Basics of Architecture and Design fundamentals Knowledge of Testing tools Knowledge of agile methodologies Understanding of Project life cycle activities on development and maintenance projects Understanding of one or more Estimation methodologies Knowledge of Quality processes Basics of business domain to understand the business requirements Analytical abilities Strong Technical Skills Good communication skills Good understanding of the technology and domain Ability to demonstrate a sound understanding of software quality assurance principles SOLID design principles and modelling methods Awareness of latest technologies and trends Excellent problem solving analytical and debugging skills Preferred Skills: Technology->Cloud Security->AWS - Infrastructure Security->AWS WAF,Technology->DevOps->DevOps Architecture Consultancy,Technology->OpenSystem->Python - OpenSystem->Python,Technology->Machine Learning->Responsible AI->ethical ai,Domain->Healthcare->Payer->FACETS,Technology->Healthcare->EDI

Candidate should have experience working as a Process Training in Claims adjudication process for US Healthcare Shift - US rotational shifts Work Location - Chennai / Bangalore Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Candidate should have team handling experience in US Healthcare for Enrollment process. Work Location - Bangalore Shift - US Shifts Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Dear Aspirants, Greeting from Sagility!! Immediate hiring for AM-Process Training in Bangalore-Work from office Job description: Role and Responsibilities The resource would be part of a dynamic team. Would be working with the other members of the training, operations and the quality teams to manage conduct of new hire training, while also being responsible for the quality performance of the newly trained resources by planning and executing various interventions during the on the job training phase. An approximate list of responsibilities is appended below (but not limited to): Should have experience working in Claims, PB, PDM & Credentialing Managing attrition and ensuring the batch throughput is as per the business targets and maintain healthy first pass yield (as per defined targets) Managing batch productivity & batch quality till the 90 days post classroom training Establishing and leading a review cadence, create performance benchmarks to measure and report to management Managing & working with clients, internal teams to drive content updation, effectiveness and availability Identifying and managing stakeholders by establishing requirements, performance reviews, collating feedback and drafting improvement plans where necessary Investing a substantial amount of time into self & team/ people development, by way of upskilling, cross skilling and formalized individual development plans Initiating or being a part of major improvement initiatives towards betterment of training practices, measurement and overall process improvement Leading a team of trainers & master trainers towards achieving laid down team goals & objectives Responsible for driving constant content review, analysis and improvements where necessary Implementing cost control through optimization of resources such as trainer availability, batch handover timelines, return on investment etc. Qualifications and Education Requirements Any graduate can apply for this position, however, should have a minimum of 5 years of U.S. Healthcare experience either in the Payor or Provider line of business, in a similar position (with people management being a key KRA). Two Way Cab will be provided. Interested candidates can share their profile to below mentioned mail ID. anitha.c@sagilityhealth.com Thanks & Regards, TA Team Sagility

Candidate should have experience working as a Process Training in Claims adjudication process for US Healthcare Shift - US rotational shifts Work Location - Chennai / Bangalore Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Rhea @ 7411697700 for more details.

Job Title - DGM - Payer Insurance Job Overview - The role of Deputy General Manager (DGM) in the Payer (Insurance) domain encompasses leadership, strategic oversight, and operational excellence. Key Responsibilities Quality Assurance - Ensure Program Quality objectives and SLAs are met. Ensure Program Quality measurements are reflective of Quality levels perceived by the client Value Creation - Deliver tangible value to the clients thru. Process Reengineering, Transformation projects leveraging Digital capability ( Automation, Analytics, etc.). Cross geo/cross tower projects. Drive client specific initiatives Efficiency Improvement - Reduce cost of operations, Reduce cost of quality, Improve productivity, Optimize Spans & Ratios, Utilization Improvement, Speed To Proficiency –Learning curve reduction Delivery Excellence - Improve process capability, Improve end to end service delivery processes, Build and leverage Continuous Improvement, Meet SLA commitments, Lead and manage Interventions People Management - Ensure employee engagement thru strong people connect and managing grievances with the help of HRBP and leadership team as appropriate. Drive team upskilling initiatives. Ensure appropriate staffing and back up plans to ensure business continuity Client relationship - Manage client conversations w.r.t. Quality and Continuous Improvement. Periodically present value-adds in business reviews. Manage and drive client satisfaction improvement projects and key actions. Skills & Attributes Masters in Business Administration or any Post-graduation will be an advantage. Around 15 to 18 years, with approx 10+ years of BPO experience Experience in US healthcare BPO is necessary Candidates with stability preferred in terms of previous job changes Preferably, should have leadership experience in manufacturing/ services in the field of Quality/ Excellence/ Operations/Automation Work experience in MNCs or reputed organizations will be an added advantage. Certified Six Sigma Black Belt from reputed institutes/companies. Role & responsibilities Preferred candidate profile

Product Owner Abacus Insights is a mission-driven, growth-stage technology company focused on transforming the healthcare payor industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. Abacus Insights provides a flexible, efficient, and secure platform that organizes and exchanges healthcare data from various sources and formats, allowing our customers to uncover differentiated insights that address their clients' needs. Our employees know that they play an active role in keeping our customers' data safe and are responsible for ensuring that our comprehensive policies and practices are met. With our deep expertise in cloud-enabled technologies and extensive knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payors access to data that has been historically siloed and inaccessible. Through our platform, these health plans can ingest and manage all the information they need to transform their business by supporting analytical, operational, and financial needs. Since our founding in 2017, Abacus has built a highly successful SaaS business. We are solving problems of massive scale and complexity in an industry that is ready for disruption. We are experiencing explosive growth and would love for you to join us. About the Team & Role: As a Product Owner at Abacus Insights, you will play a pivotal role in bringing to market a cutting-edge cloud data platform which enables an industry leading data usability for Healthcare Payors, ultimately enabling them to turn their vast data into insights that drive improved outcomes. This role requires a robust background in software development or data engineering to effectively translate high-level product vision and customer needs into detailed requirements. You will be working collaboratively with engineering and stakeholders from across the organization to ensure the development of features that optimize value and meet customer needs. As a key member of the product team, you will be responsible for managing Abacus products throughout their lifecycle to include opportunity identification, demand intake, roadmap management, requirement development and analysis, story grooming, design reviews, product acceptance, go-to-market, and sunset planning. This role requires a person who can successfully manage across all aspects of product management while keeping focused on delivering true customer ROI and excelling as a technical translator of business need into technical specifications. Primary Responsibilities: Translate the strategic direction set by the Product Manager into specific product features and oversee development of these features efficiently within the agile framework. Support engineers comprehensively throughout all aspects of the Software Development Life Cycle (SDLC), providing guidance, insights, and assistance as necessary. Assume end-to-end responsibility for the lifecycle of product features you own Act as the primary translator between business needs and technical requirements, effectively bridging the gap to ensure alignment between stakeholders and engineering teams. Work with cross-functional teams to analyze current product performance and identify areas for improvement. Communicate comprehensive updates, progress reports, and insights related to the product's development to company leadership and other audiences. Collaborate with stakeholders, customers, and the development team to gather comprehensive requirements and document customer scenarios, pain points, and success criteria for product feature-sets and features. Estimate anticipated impact of each product feature and craft effective value statements to be used in roadmap prioritization. Create, prioritize, and manage the product backlog to ensure that the team is working on the most valuable items first. Ensure that the development team understands the scope and complexity of the tasks and can accurately estimate the level of development effort. Participate in sprint planning, reviews, and retrospectives, ensuring that the development team is building the product as envisioned and meeting the acceptance criteria. Act as the primary liaison between stakeholders and the development team, conveying updates, managing expectations, and gathering feedback. Ensure visibility, transparency, and clarity of the product backlog for all stakeholders involved. Manage product acceptance testing phases to ensure features not only add value but also align with customer needs. Coordinate release activities to ensure seamless deployment. Prepare relevant documentation and conduct internal user training for new features. Collaborate with client management to ensure they have what they need to support our clients in optimizing the impact of the product. What We're Looking For: A deep understanding of data software engineering or a minimum of 3 years of software development or data engineering experience. Domain expertise in shipping Software as a Service (SaaS) products. Deep domain expertise in cloud technologies, including AWS, Azure and/or GCP. Skilled in database concepts and tools (preferably on Databricks and Snowflake). Deep understanding of the data platform R&D processes and agile methodologies. Experience with big data, ETL and data pipelines, security and privacy, DevOps, or automation. BS or MS in Computer Science, or related fields, or equivalent experience in a technical product owner role or an adjacent position. Proven ability to influence and coordinate cross-functional teams to execute plans in highly technical environments. Exceptional communication skills critical for translating business requirements into technical specifications, and communicating with technical and non-technical audiences. Well-developed strategic-thinking skills, with the ability to inspire and lead others. A highly proactive get it done attitude and the skills to back it up. Demonstrated ability to thrive in a fast-paced, dynamic startup environment. Bonus Points: US Healthcare Payor or Provider industry experience. Experience with healthcare interoperability standards such as HL7 V2, FHIR and X12. Experience with integrating or implementing healthcare-related EMPI/MDM workflows. Equal Opportunity Employer

Role & responsibilities 18+ years of experience in program management , service delivery, or transformation initiatives within the US healthcare Payer domain. Deep understanding of healthcare industry dynamics, including provider, payer, and regulatory environments. Expertise in project management frameworks (e.g., Agile, Waterfall) and tools (e.g., MS Project, JIRA). Support legacy system modernization efforts and migration to modern platforms. Loc : Chennai / Hyderabad

Role: Operating Leader Revenue Cycle Management Location: Gurgaon Role Overview: We are seeking an experienced and results-driven Operating Leader to oversee large-scale revenue cycle management (RCM) operations, managing end-to-end service delivery, client relationships, and P&L for accounts and annual revenue management. This is a strategic role within the Healthcare vertical and will directly report to the Global Head of Healthcare Operations based in India. The Operating Leader should possess a strong track record in operational excellence, strategic client engagement, team leadership, and financial performance management in the healthcare RCM domain. Will be responsible for providing leadership and subject matter expertise in the Provider and Payer areas with Primary focus on RCM. The personnel will be responsible for driving growth and innovation within existing clients and new potential healthcare customers. The ideal applicant should bring 16+ years of experience in the US Payer and Provider area with at least 10+ years in Revenue Cycle Management. Prior Experience in BPO/Captive operations with hands on experience leading provider practice management systems will be an added advantage. Key Responsibilities: Operational Leadership Lead delivery and operational performance across assigned Provider and/or Payer accounts right from Transition to BAU. Should implement best practices and risk mitigation strategies for new and existing RCM operations Drive productivity, efficiency, and compliance across end-to-end RCM functions (coding, billing, collections, A/R, denials, etc.). Oversee multi-site or global delivery teams, ensuring high-quality service and SLAs are met. P&L Management: Own P&L responsibility for a high value business portfolio Drive revenue growth and profitability improvements through operational excellence, automation, and strategic account management. Develop and manage budgets, forecasts, and financial reporting for assigned portfolios. Own the P&L for the healthcare vertical, ensuring achievement of financial goals through data-driven decision-making and cost optimization. Strategic Initiatives and Process Improvement: Partner with senior leadership on strategic initiatives in RCM, including automation, analytics, digital transformation, and new service offerings. Lead transformation projects that drive cost reduction, enhance quality, and scale operations. Proactively work with technology and transformation teams to implement automation and reduce cost of operations Leverage advanced analytical skills to monitor performance metrics, identify trends, and implement corrective actions for sustained growth People & Performance Management Lead large, cross-functional teams, including front-line managers and operational support functions. Build differentiated RCM operating environment Foster a First Time Right team culture Mentor and develop operational leaders to ensure a strong succession pipeline. Foster a culture of accountability, continuous improvement, and employee engagement. Client Relationship Management Serve as a strategic partner to clients, understanding their business needs and proactively identifying value-add opportunities. Manage executive-level stakeholder relationships and provide regular business reviews and performance updates. Ensure high levels of client satisfaction and retention. Candidate Profile: Bachelors degree in Business, Healthcare Administration, or related field (MBA or advanced degree preferred). Minimum 16 years of experience in BPO/Captive operations focused on US Healthcare RCM. Proven expertise in managing large-scale healthcare operations across geographies. Strong financial acumen with a demonstrated ability to manage P&L and drive profitability. Deep understanding of healthcare industry trends, compliance, and best practices. Exceptional leadership, communication, and stakeholder management skills. Strategic thinker with a hands-on approach to execution and team development. Deep expertise in end-to-end Revenue Cycle Management (RCM), including patient registration, insurance verification, medical coding, charge entry, claims submission, payment posting, denial management, and AR follow-up. Preferred Skills: Exposure to global delivery models (India, Philippines, Nearshore). Knowledge of healthcare IT platforms (e.g., Epic, Cerner, Athena). Experience driving digital/automation initiatives (e.g., RPA, AI, analytics). Six Sigma or Lean certification (preferred but not required). Qualifications Bachelors Degree

Job Title: AVP Capability Development Job Type: Full Time Function/Department: Capability Development Role Description: the AVP will oversee and lead the Quality Management function across operations, ensuring world-class quality standards are met, continuous improvement is fostered, and client expectations are consistently exceeded. The individual in this role will manage quality assurance (QA), quality control (QC), and process improvement initiatives, while guiding teams to enhance overall business performance and customer satisfaction. This position requires a strong blend of strategic vision, operational experience, leadership, and deep expertise in quality management principles. Roles & Responsibilities Leadership & Strategic Vision: Lead and mentor a high-performing Quality team, fostering a culture of continuous improvement, accountability, and operational excellence. Develop and execute a comprehensive quality strategy to enhance customer satisfaction, reduce operational costs, and drive business growth. Partner with senior leadership (Operations, HR, Training) to align quality strategies with business objectives and client goals. Provide subject-matter expertise and thought leadership on industry best practices in quality management. Quality Management & Improvement: Oversee the end-to-end Quality Management process for all business units, ensuring robust measurement frameworks, audits, and performance metrics are established and tracked. Monitor performance through KPIs and analytics to identify trends, gaps, and improvement opportunities. Implement and drive Six Sigma, Lean, and other process improvement methodologies to improve operational efficiencies and reduce defects. Conduct root-cause analysis for quality issues, develop corrective actions, and track improvement initiatives. Client & Stakeholder Management: Serve as the primary point of contact for quality-related matters with clients, ensuring their expectations are met or exceeded. Engage in regular discussions with clients to understand their quality requirements, challenges, and performance expectations. Present quality performance reports and insights to senior leadership, stakeholders, and clients, making data-driven recommendations for improvement. Training & Development: Collaborate with the Training and Learning & Development teams to ensure all associates are trained on quality standards, process best practices, and compliance requirements. Design and conduct quality training programs to enhance team capabilities and maintain consistent quality performance across the organization. Create and maintain a knowledge-sharing environment that promotes cross-functional learning. Risk Management & Compliance: Monitor compliance with regulatory and quality standards, ensuring all processes and outcomes align with industry regulations and company policies. Identify potential risks related to quality management and implement mitigation strategies. Drive audit readiness and ensure teams are prepared for internal and external audits. Technology & Tools: Leverage technology solutions (e.g., analytics, automation tools) to enhance quality management systems and reporting capabilities. Stay updated on the latest trends and tools in quality management, making recommendations for tool adoption where appropriate. Preferred Work Experience 10-15 years of experience in quality management, process improvement, or a related field, with at least 5 years in a leadership position (AVP, Senior Manager, or equivalent). Proven track record in managing large-scale quality operations, ideally within a BPO, IT outsourcing, or customer service environment. Strong expertise in Lean, Six Sigma, or other quality improvement methodologies (Green Belt/Black Belt certification preferred). Competencies & Skills Strong leadership skills with the ability to motivate, guide, and develop teams in a high-pressure environment. Expertise in designing and implementing quality assurance frameworks and quality control mechanisms. Excellent data analysis skills, with the ability to generate insights from complex datasets. Ability to drive business process optimization initiatives using Lean, Six Sigma, or similar frameworks. Exceptional communication and interpersonal skills, with the ability to collaborate effectively with internal teams and external clients. High-level understanding of customer-centric operations, with a keen eye on operational efficiency and client satisfaction.

Role: Healthcare Payer Presales & Solutioning Lead Location: Gr. Noida/Mumbai Experience: 15+ years Mode: work from office Description: Responsible for driving presales & solutioning activities for the health insurance (payer) segment of the organizations healthcare & life sciences business unit. Strong experience in a domain consulting / solutioning role in the US health insurance (payer) domain with expertise in payer workflows, regulations, technology landscape, trends, etc. Experience in BPaaS offerings for payers, TPA, MCO, VBC, etc. would be preferred. 15+ years of overall industry experience, 10+ years in healthcare and payer segment. Proven business assessment and solutioning skills in tracking industry trends, customer business, product portfolios, etc., conceptualizing differentiated AI-led techno-functional solutions and driving presales/GTM. Entrepreneurial and growth-oriented mindset with the ability to execute seamlessly in a dynamic business environment. Strong presentation, written and verbal skills to interface with prospects, partners, analysts and organization stakeholders across multiple sites to identify, map, create and position relevant solutions, offerings and value proposition for driving HCLS business growth. [Duties and responsibilities] Monitor HCLS industry & emerging technology trends to identify, map / create and position relevant solutions, offerings and value prop. Drive evolution of offerings, solutions, and roll-out of new capabilities Help define/refine GTM strategy and drive marketing efforts for HCLS BU working closely with relevant stakeholders, including industry, technology, and customer research/analysis for targeted outreach. Work with Identified partners, analysts and sales team(s) in executing GTM strategies for taking existing and new offerings to customers Drive customer and internal meetings and workshops to identify & position appropriate solutions, offerings and value proposition, and gain stakeholder approvals.

Role & responsibilities BA - APLD Analyst Experience level: 3 to 5 years Mandatory: US APLD, SQL, Excel, PowerPoint Good to have: Python, PySpark, Any BI tool, EU work exposure Preferred candidate profile Perks and benefits

Senior Vice President of Engineering and Technology - Healthcare Payer Domain Key Responsibilities: Strategic Leadership: Lead the development and execution of technology-driven strategies for payer operations, focusing on automation, AI, and data analytics to optimize claims processing, member engagement, and cost containment. Stay updated on industry trends, regulatory changes (CMS, ACA), and emerging technologies to adapt payer strategies. Operational Excellence: Oversee technology platforms supporting payer operations, ensuring accurate claims processing and reimbursement. Drive automation and efficiency initiatives to reduce operational costs and improve service delivery. Technology & Data Integration: Collaborate with IT teams to implement advanced systems for claims adjudication, payment integrity, and member engagement. Utilize data analytics and AI to enhance risk management, improve care outcomes, and support value-based payment models. Ensure compliance with healthcare standards (EDI, HIPAA, FHIR). Leadership & Team Building: Build and lead cross-functional teams in payer operations, technology, and analytics to drive innovation and continuous improvement. Foster a collaborative culture and provide mentorship to team members. Stakeholder Management: Strengthen relationships with providers, regulators, and other stakeholders through technology-driven service improvements. Represent the organization in tech-focused forums and regulatory discussions. Financial Management: Oversee technology budgets to ensure cost-effectiveness and ROI. Leverage technology to reduce medical loss ratios (MLR) and optimize revenue streams. Qualifications: Bachelor's degree in Healthcare IT, Business, or related field; advanced degree preferred. 25+ years of experience in healthcare payer roles, with a strong focus on technology solutions like claims systems and analytics platforms. In-depth knowledge of payer regulations (CMS, HIPAA, ACA) and technology standards. Strong leadership, strategic thinking, and problem-solving skills.

We at EMIDS, are hiring for QA Lead role. Please find the details below and share your interest at aarati.pardhi@emids.com Exp: 9+ yrs Location : Bangalore / Hyderabad Job Summary: We are seeking a highly skilled QA Lead with strong domain expertise in U.S. healthcare insurance. The ideal candidate will have deep knowledge of Health Rules modules, hands-on experience in SQL and EDI testing, and proven ability to lead QA efforts in an Agile environment. This role requires cross-functional collaboration with business analysts, development teams, and stakeholders to ensure the quality and integrity of healthcare applications. Key Responsibilities: Lead QA efforts across multiple systems and coordinate with cross-functional teams (QA, BA, Dev). Review and analyze business requirements to develop comprehensive test strategies and plans. Conduct detailed testing of various Health Rules modules, including: Benefits Providers Provider Contracts Enrollments and Account Configurations Claims testing based on configured Benefit Plans and Provider Contracts Execute and validate data migration using strong SQL skills. Healthcare Domain knowledge Health Rules Payer Application EDI SQL Perform end-to-end testing of EDI files: 837, 834, 835, 999, ensuring compliance with healthcare standards. Participate actively in Agile ceremonies: Sprint Planning, Daily Stand-ups, Sprint Reviews, and Demos. Ensure timely delivery of quality assurance tasks and deliverables within the sprint timelines. Mentor and guide junior QA team members and ensure adherence to best QA practices. Required Skills: Strong domain knowledge of U.S. Healthcare Insurance industry. Experience in Health Rules configuration and testing. Proficient in SQL strong experience in writing complex queries and validating data migration. Hands-on experience testing EDI transactions: 837, 834, 835, 999. Solid understanding and practical experience with Agile methodologies, especially Scrum. Proven experience in leading QA efforts across integrated systems and collaborating with BA teams. Strong analytical, communication, and leadership skills.