DOMA Technologies · 1 day ago
Healthcare Payer Strategist
Virginia Beach, VA
Full-time
Hybrid
Senior Level
7+ years expDOMA Technologies is focused on data-centric transformation in healthcare, seeking a Healthcare Payer Strategist to support growth in the Commercial Healthcare markets. The role involves serving as an expert on payer operations and collaborating with various teams to translate complex payer workflows into practical solutions that enhance healthcare outcomes and efficiency.
Cloud Data ServicesDocument ManagementEnterpriseInformation TechnologySoftware
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
DOMA Technologies
DOMA is a game changing tech innovator that frames all of its endeavors through its passion for people.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2024-11-13Acquired
Leadership Team
Pat Feliciano
President & CEO
Damian Breland
Chief Technology Officer
Recent News
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