Domain Expert

4 weeks ago

Hyderabad, India Tredence Inc. Full time

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.

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