Senior Vice President

2 weeks ago

Hyderabad, Telangana, India People Impact Full time

Location : Chennai/Hyderabad.

Key Responsibilities:

Strategic Leadership:

- Develop and implement a long-range plan for the payer domain-including member engagement, provider contracting, claims integrity, and value-based reimbursement.

- Drive innovation through data analytics, AI, automation, and predictive modeling.

- Monitor trends in CMS, ACA, FHIR, HIPAA, and EDI standards, adapting strategy proactively.

Technology & Product Leadership:

- Partner with product and engineering teams to deploy advanced claims adjudication systems, payment integrity platforms, and member/provider CRM portals.

- Integrate analytics and predictive risk models to optimize value-based payment programs.

- Ensure interoperability, FHIR compliance, and robust data privacy/security standards.

Operational Excellence:

- Oversee end-to-end payer technology delivery-claims adjudication workflows, payment post- processing, provider reimbursement models, and customer-facing systems.

- Drive cross- functional initiatives to reduce administrative costs and minimize claim denials and leakage.

Team Leadership & Talent Development:

- Build and mentor high-performing product, engineering, and project management teams.

- Cultivate a culture of collaboration, innovation, accountability, and continuous improvement.

Stakeholder Management:

- Engage key external stakeholders: payers, providers, brokers, employers, and regulatory bodies.

- Collaborate with clinical/population health leaders to align payer strategy with care delivery goals.

- Represent your organization in industry forums, trade associations, and legislative engagements.

Financial & Value Management:

- Drive financial strategy for payer services, optimizing ROI and reducing medical loss ratio (MLR).

- Oversee budgets, pricing models, and cost-reduction strategies tied to value-based contracting and digital automation.

Qualifications:

- Education: Bachelor's in Healthcare Administration, Business, or related field; MBA, MHA, or advanced degree strongly preferred.

- Experience: 25+ years of progressive leadership in healthcare payer domain, leading product or engineering-driven payer transformation.

- Domain Expertise: Deep knowledge of claims adjudication, provider contracting, reimbursement models (FFS / value- based), risk adjustment, and member engagement platforms.

- Technical Acumen: Hands-on experience with payer systems (analytics platforms, CRM, adjudication engines), interoperability standards (EDI, FHIR), and data security regulations (HIPAA).

- Leadership Fit: Track record of building and leading large teams, partnering across executive, clinical, finance, and technology functions.

- Communication & Influence: Exceptional presence with ability to engage Executive and Board-level stakeholders, negotiate complex payer contracts, and drive thought leadership.

(ref:iimjobs.com)

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