Visionary Payer Services Director

2 days ago

Hyderabad, Telangana, India beBeeExecutive Full time ₹ 40,00,000 - ₹ 50,00,000
Senior Executive Leader

We are seeking a highly skilled Senior Vice President to lead our business division.

Key Responsibilities:

  • Develop and implement a long-range strategy 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.
    • Evaluate interoperability, FHIR compliance, and robust data privacy/security standards.
  • Operational Excellence:
    • Oversee end-to-end payer technology delivery, including 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:
    • Brew 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.

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