Commence · 2 days ago
Healthcare Payer Strategist
Virginia Beach, VA
Full-time
Hybrid
Senior Level
7+ years expCommence is at the forefront of data-centric transformation in healthcare, aiming to elevate health outcomes and improve patient care. The Healthcare Payer Strategist will be a key player in the company's growth within the Commercial Healthcare markets, serving as an expert on payer operations and translating complex workflows into effective solutions.
AnalyticsArtificial Intelligence (AI)Clinical TrialsCloud ComputingHealth CareSoftware
Responsibilities
Serve as the primary expert on healthcare payer operations, including Medicaid, Medicare, and commercial insurance workflows, policies, and regulations
Support sales and pre-sales activities by providing specific expertise during discovery, solution design and customer presentations
Translate complex payer requirements into clear product use cases, configuration guidance and solution recommendations
Partner with product management and engineering to ensure payer needs, compliance requirements and workflow realities are reflected in product design and roadmap decisions
Provide guidance during customer implementations to ensure solutions align with payer business processes and regulatory standards
Function as a trusted advisor to customers to help them optimize their use of the platform to achieve program, compliance and financial outcomes
Develop and maintain payer focused documentation, best practices and enablement materials for internal teams and clients
Stay current on healthcare policy, reimbursement models, fraud, waste and abuse (FWA) programs and regulatory changes that impact payers
Support customer success and support teams in resolving complex payer related issues and escalations
Assist in identifying new product opportunities based on emerging payer needs, data trends and regulatory shifts
Participate in industry forums, conferences and customer meetings to represent payer expertise and strengthen the company’s credibility
Help train and enable internal teams (Sales, CSMs, Support) on payer concepts, workflows, and compliance considerations
Other duties as requested or assigned by supervisor
Qualification
Required
Bachelor's degree in healthcare administration, public health or another related field
Minimum of 7+ years of experience working within healthcare payer organizations (Medicaid, Medicare or commercial insurance) or in a payer focused consulting or technology role
Deep knowledge of payer operations, including claims processing, eligibility, provider networks, utilization management and payment integrity
Strong understanding of healthcare regulations and compliance frameworks, including CMS guidelines, HIPAA and state Medicaid requirements
Experience working directly with product, engineering or data teams to define requirements and validate solutions
Strong written and verbal communication skills with the ability to engage with senior-level stakeholders as needed
Proven ability to serve as a trusted advisor to customers, executives and internal stakeholders
Demonstrated ability to work solo as well as being a productive team member
Must be able to travel within the United States on a quarterly basis while maintaining professionalism
Company
Commence
Commence delivers AI-driven healthcare data platform and clinical expertise that supports analytics, decisions, and workflow improvement.
501-1000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase