Sme - Health Insurance - Project Manager

Number of Positions:

: 1

Primary Skills:

: SENIOR CONSULTANT IN THE LIFE/GENERAL/HEALTH INSURANCE DOMAIN

Job Description:

Job Title: Health Insurance & Healthcare (Payer/Provider) Domain SME

Location: Coimbatore, India

Job Summary:

We are looking for a highly skilled Subject Matter Expert (SME) in Health Insurance & Healthcare (Payer/Provider) to join our team in Coimbatore. The ideal candidate should have a minimum of 7 years of domain experience across India, APAC, the Middle East, US, and Europe markets, along with at least 5 years of hands-on experience in IT services or Health Insurance/Healthcare IT Product/Platform industry. Industry-recognized certifications in health insurance, healthcare, or IT platforms are required.

Key Responsibilities:

Domain Expertise & Consulting:

Provide expert insights into health insurance products, healthcare payer/provider processes, and market trends across multiple geographies.

Analyze business requirements and translate them into IT solutions aligned with industry best practices.

Collaborate with stakeholders to improve business processes, claims management, underwriting, and provider network operations.

IT Services & Product/Platform Expertise:

Work closely with IT teams to design, develop, and implement health insurance and healthcare technology solutions.

Contribute to the enhancement of healthcare payer/provider platforms and products with domain expertise.

Support pre-sales, solutioning, and proposal development by providing domain insights.

Regulatory & Compliance Advisory:

Stay updated on health insurance regulations, compliance standards, and government policies across different regions.

Ensure IT solutions and business processes adhere to regulatory requirements like HIPAA, ICD-10, HL7, FHIR, IRDAI, CMS, and GDPR (depending on geography).

Provide risk assessment, policy framework development, and compliance reporting support.

Training & Knowledge Management:

Conduct training sessions, workshops, and knowledge-sharing initiatives for internal teams and clients.

Develop domain-specific documentation, best practices, and case studies.

Required Qualifications & Experience:

Experience:

Minimum 7 years in the Health Insurance & Healthcare (Payer/Provider) domain.

5+ years in IT services or Health Insurance/Healthcare IT Product/Platform industry.

Certifications (Preferred):

AHIP (America's Health Insurance Plans)

LOMA (Life Office Management Association) - Health Insurance modules

HIPAA, ICD-10, HL7, FHIR certifications

Certified Health Insurance Specialist (CHIS) or equivalent

Geographical Exposure:

Experience with health insurance & healthcare businesses in India, APAC, Middle East, US, or Europe.

IT & Digital Expertise:

Experience in healthcare digital transformation, insurtech solutions, or payer/provider platforms.

Familiarity with claims adjudication systems, policy administration systems, AI-driven healthcare applications, and automation.

Skills:

Strong analytical, problem-solving, and consulting skills.

Excellent communication, stakeholder management, and client interaction abilities.

Ability to work cross-functionally with IT, business, and compliance teams.

Preferred Qualifications:

Knowledge of population health management, revenue cycle management (RCM), value-based care, and interoperability standards.

Experience with cloud-based health insurance solutions, AI/ML in healthcare, and predictive analytics.

Hands-on experience in Agile, DevOps, or SaaS-based healthcare solutions.

This role offers a dynamic and impactful opportunity for professionals looking to leverage their healthcare domain expertise in a technology-driven insurance & healthcare ecosystem.