Domain Expert

1 week 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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