Healthcare Business Process Consultant – Core Admin & Technology Strategy - Trivandrum

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Roles & Responsibilities:

• Design operational and technology blueprints to enhance healthcare payer core administration capabilities.
• Provide cross-functional consulting on core admin platform strategy, implementation, and process optimization.
• Build business cases focused on cost savings, performance improvement, and reduction in Total Cost of Ownership (TCO).
• Apply industry and geography-specific regulatory knowledge to inform decision-making and ensure compliance.
• Deliver insights on market/industry trends, competitive product landscapes, and customer business domains.
• Advise on COTS products and vendor selection strategies; guide implementation types such as upgrades, conversions, and migrations.
• Use frameworks like BPM, Value Stream Mapping, and process harmonization to assess and improve business processes.
• Lead requirement gathering and analysis efforts, creating artifacts such as blueprints, workflows, and functional specs.
• Support governance and maintain quality through project management tools, estimation techniques, and metrics.
• Collaborate with client and internal stakeholders to structure solutions using UST offerings and domain-specific COTS tools.
• Guide the use of project governance frameworks, RACI matrix, and effective knowledge management practices.
• Understand pricing/licensing models and contribute to developing proposals and delivery models.

Must-Have Skills:

• Strong domain knowledge in Healthcare Payer operations and core administration platforms.
• Proven experience in process consulting, BPM, and business transformation in a healthcare context.
• Working knowledge of COTS healthcare products and their implementation life cycle (e.g., Facets, QNXT, HealthRules).
• Expertise in requirement elicitation, process mapping, and documentation standards.
• Familiarity with project management practices including scoping, risk management, estimation, and delivery metrics.
• Strong communication and stakeholder management skills; ability to liaise between technical and business teams.
• Understanding of industry regulations and compliance (HIPAA, NCQA, CMS).

Good-to-Have Skills:

• Exposure to competitive product landscapes and emerging technologies in healthcare platforms.
• Knowledge of pricing/licensing models and advanced commercial models (e.g., outcome-based pricing).
• Familiarity with tools such as Visio, MPP, JIRA, and knowledge management platforms (wikis, portals).
• Experience working with consulting frameworks, vendor evaluation processes, and client engagements.
• Background in estimation models like UCP, FP, and resource planning techniques.