Healthcare Consulting

Location: Pune, Chennai, Bengaluru, Kolkata, Hyderabad, Mumbai, Noida   •   Experience: Mid Level   •   Openings: 4
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Job description

1. Job Details
Job Title: Healthcare Consulting 
Job Location: Bangalore/Hyderabad/Chennai/Pune/Mumbai /Noida/Kolkata
Work Model: Hybrid

2. Candidate Expectations
Total Experience and Relevant Experience – 6+Years
Candidate Location : Bangalore/Hyderabad/Chennai/Pune/Mumbai /Noida/Kolkata
Skills – HIPAA, Medicare/Medicaid guidelines
Candidate Industry (BPO / KPO / GBS / GCC / GSS / Captive Shared Services)
Diversity – N/A

3. Education and Certification

Qualification: Mandatory: B.Tech /B.E /BDS and Good to Have : MBA (Fulltime)


Specific Remarks: Distance education not accepted, 15 years regular stream mandatory, etc.

4. Detailed Job Description

Key Responsibilities:
  • Domain Expertise: Serve as a Subject Matter Expert (SME) in one or more areas: Claims Adjudication, Membership/Enrolment, Utilization Management (UM), Prior Authorization, or Revenue Cycle Management (RCM). Recommend solutions for Value-based care, HEDIS/STAR rating improvements, and digital transformation
  • Regulatory Compliance: Ensure deliverables adhere to HIPAA, Medicare/Medicaid guidelines, and federal/state-specific regulations
  • Product Management: Define and communicate product vision and strategy, manage backlogs (Jira/ADO, Rally), and translate complex clinical/business needs into actionable requirements
  • Stakeholder Collaboration: Engage with internal and external stakeholders, including clients, consultants, and technology teams, to gather requirements and feedback.
  • Performance Monitoring: Monitor and analyze product performance metrics and risks, using data-driven insights to drive continuous improvement.
  • Market Trends: Stay informed about industry trends, emerging technologies, and best practices to ensure the product remains competitive and innovative.
  • Experience:
    • 6+ years of experience in healthcare domain as a Consultant, Product Owner, or similar role in a technology-focused environment. 
    • Must have US related healthcare experience in areas such as Medicare, Medicaid, Duals, Claims, Enrolment, Encounters, Interoperability, PBM, Providers etc.
    • Understanding of Solution architecture, EDI transactions, HL7 and FHIR standards
    • Experience working with Agile/Scrum methodologies and tools. 
5. Key Skills
Mandatory Key Skills: Must have US related healthcare experience in areas such as Medicare, Medicaid, Duals, Claims, Enrolment, Encounters, Interoperability, PBM, Providers, Claims Adjudication, Membership/Enrolment, Utilization Management (UM), Prior Authorization, or Revenue Cycle Management (RCM). Recommend solutions for Value-based care, HEDIS/STAR rating improvements, and digital transformation etc.

6.Good to Have Skills: Understanding of Solution architecture, EDI transactions, HL7 and FHIR standards