Back to jobsLead large-scale digital transformation programs, including legacy system replatforming, data normalization, and modernization efforts.
Elicit, analyze, and translate business requirements into clear technical specifications and process flows, leveraging expertise in healthcare payer domain (claims, membership, billing, provider modules).
Work with pricer tools and expertise in pricing of claims, fee schedules, contracts, and payer concepts to ensure accurate claims adjudication and financial modeling.
Leverage knowledge of 837 claim transaction sets and Electronic Data Interchange (EDI) standards to support claims processing and integration.
Collaborate closely with cross-functional teams including architects, developers, QA, and offshore teams to ensure high-quality, timely delivery.
Drive requirements transformation, ambiguity resolution, and change management to support agile and waterfall SDLC methodologies.
Define and document reference architectures, data flows, and process models to facilitate shared expertise and compliance.
Support solution design and integration initiatives using APIs, SOA, RESTful/SOAP web services, and enterprise system extensions.
Utilize strong data modeling, SQL, and ETL skills to support data extraction, transformation, and reporting activities across heterogeneous data sources.
Partner with technical leads and project managers to monitor program health, risks, and deliverables ensuring alignment with business objectives.
Champion best practices in business assurance, quality management, and automation strategies.
