Executive Payer Transformation Leader

2 days ago

Hyderabad, Telangana, India beBeeTransformation Full time ₹ 2,00,00,000 - ₹ 2,50,00,000
Job Description

We are seeking an experienced Executive to lead our payer domain initiatives. The ideal candidate will have a strong track record of building and leading large teams in the healthcare payer industry.

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: Leverage data analytics, AI, automation, and predictive modeling to drive innovation and stay ahead of trends in CMS, ACA, FHIR, HIPAA, and EDI standards.
  • Technology & Product Leadership: Partner with product and engineering teams to deploy advanced claims adjudication systems, payment integrity platforms, and member/provider CRM portals.
  • Operational Excellence: Oversee end-to-end payer technology delivery, including claims adjudication workflows, payment post-processing, provider reimbursement models, and customer-facing systems.
  • Team Leadership & Talent Development: Build and mentor high-performing product, engineering, and project management teams, fostering a culture of collaboration, innovation, accountability, and continuous improvement.
  • Stakeholder Management: Engage key external stakeholders, including payers, providers, brokers, employers, and regulatory bodies, representing 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), overseeing budgets, pricing models, and cost-reduction strategies tied to value-based contracting and digital automation.
Required Skills and 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.

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