Healthcare Payer Consultant
Job Summary
To optimize member and provider communications, the full-time Healthcare Payer Consultant will serve as a subject matter expert in Utilization Management and Appeals & Grievances, configuring solutions and consulting with clients remotely.
Key responsibilities
- Serve as a subject matter expert for Utilization Management and Appeals & Grievances workflows within healthcare payer organizations
- Consult with clients on complex Medicare and commercial letter requirements, including business rules and communication design
- Manage multiple project timelines while collaborating with offshore teams and cross-functional stakeholders to achieve project objectives
Required qualifications
- Strong experience supporting healthcare payer operations, including Utilization Management and Appeals & Grievances processes
- Advanced knowledge of QNXT UM and/or A&G
- Experience gathering business requirements and translating them into client solutions
- Working knowledge of XML design and content development
- Intermediate proficiency with Adobe Illustrator, Photoshop, and InDesign
Complete Job Description
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