Perficient · 1 day ago
Payer Modernization Strategist SME
2000 44th Street SW, Suite 601, Fargo, ND, 58103, US
Full-time
Hybrid
Senior Level, Lead/Staff
$104K/yr - $210K/yr
8+ years expPerficient is a global AI-first consultancy that partners with innovative enterprises to deliver business results through AI. The Payer Modernization Strategist SME will serve as a trusted advisor to clients, guiding them through modernization initiatives and ensuring seamless integration of payer systems.
ConsultingInformation TechnologyInternetMarketing
Responsibilities
Guide payers through modernization trends and interoperability requirements, including AI
Translate regulatory and market changes into clear implications and options for clients
Maintain expertise in federal and state programs impacting payers (e.g., CMS Interoperability, Prior Authorization)
Advise clients on compliance strategies and help internal teams understand regulatory demands
Partner with account teams to shape proposals, respond to RFPs, and represent SME expertise in client meetings
Contribute to solution narratives, scoping, and estimates for engagements
Serve as domain lead on payer-focused projects, ensuring scope and deliverables align with industry best practices
Collaborate with project managers and technical experts to implement solutions that address regulatory and market changes
Develop client-facing presentations, playbooks, and training sessions on compliance, interoperability, and modernization
Contribute to white papers, webinars, and conference content to showcase industry expertise
Qualification
Required
8–12+ years of experience in healthcare consulting, payer strategy, or enterprise system implementations
Demonstrated success leading strategic initiatives and supporting sales/RFP efforts
Hands-on experience with implementation of key payer systems (claims, benefits, prior authorization, care management)
Experience advising leadership on regulatory mandates and market conditions and impact to stakeholders
Strong experience with payer systems and processes across functional areas (claims, benefits, provider networks, contracting, wellness, etc.)
Expertise in system integration, interoperability, and data flow across payer platforms
Proven experience responding to regulatory changes such as CMS Interoperability and Prior Authorization rules
Knowledge of healthcare policy and regulatory topics impacting payer operations
Proficient in leveraging AI technologies to drive innovation, support strategic initiatives, and enable data-driven decision-making
Possesses a strong understanding of AI capabilities, limitations, and ethical considerations
Exceptional communication skills; able to simplify complex regulations for executive audiences
Strategic thinker with the ability to frame problems, options, and trade-offs
Credible presence with senior payer leaders; able to influence and build consensus
Collaborative, low-ego style; effective in cross-functional teams
Comfortable working in dynamic environments with multiple clients and initiatives
Bachelor's degree in healthcare, business, technology or related fields
Expectation for some travel and local office on-site may be required (depending on location and requirements)
Preferred
Master's degree in healthcare, business, technology or related fields
Company
Perficient
Perficient is an IT consulting firm that helps companies adapt their systems to third party software products that use internet.
5001-10000 employees
Funding
Current Stage
Public CompanyTotal Funding
$65.3M2024-05-05Acquired
2024-01-17Post Ipo Equity· $4.44M
2022-10-17Post Ipo Equity· $5.18M
Leadership Team
Ed Hofffman
Senior Vice President, North America Business Operations
Hari Madamalla
Vice President
Recent News
2025-11-10
Dallas Innovates
2025-10-11
Company data provided by crunchbase