AddSource · 6 hours ago
Sr. Healthcare Payer SME
United States
Contract
Remote
Senior Level, Lead/Staff
8+ years expAddSource is seeking a highly experienced Senior Healthcare Consultant with expertise in healthcare, particularly in claims processing and population health. This role involves leading healthcare initiatives, optimizing member engagement, and integrating AI-driven solutions to enhance patient experience and health outcomes.
Information Technology & Services
Hiring Manager
Hardeep Kaur
Responsibilities
Serve as a subject matter expert across healthcare domains including payer operations, clinical workflows, and regulatory compliance. Provide clinical leadership and guidance to internal teams and clients
Collaborate with stakeholders to elicit business and functional requirements. Create comprehensive Business Requirement Documents (BRDs) and Functional Requirement Documents (FRDs)
Analyze and optimize claims processing workflows. Identify and resolve backend operational inefficiencies
Design and support population health strategies including risk stratification, care coordination, and quality improvement. Leverage data to drive insights and improve patient outcomes
Assess current HEDIS performance and identify gaps. Recommend and implement strategies to enhance HEDIS scores and compliance
Apply AI and machine learning techniques to healthcare data for predictive analytics, risk modeling, and operational insights. Collaborate with data science teams to develop and deploy AI solutions that support clinical and business objectives
Develop and implement strategies to improve member engagement through digital tools and personalized outreach. Collaborate with product and IT teams to enhance member portal functionality, usability, and adoption. Use analytics to monitor member behavior and identify opportunities for improved engagement and satisfaction
Conduct active market research to identify trends, opportunities, and competitive benchmarks. Translate research findings into strategic recommendations for clients and internal teams
Act as a health coach to support patient engagement and behavior change. Advocate for evidence-based practices and patient-centered care models
Qualification
Required
8+ years of experience in healthcare consulting or related roles
Proven expertise in claims processing, population health, HEDIS, and member engagement
Experience with AI tools and platforms used in healthcare (e.g., predictive analytics, NLP, machine learning)
Familiarity with member portals and digital health engagement platforms
Strong analytical, documentation, and communication skills
Ability to work cross-functionally with clinical, technical, and business teams
Bachelor's or Master's degree in Healthcare Administration, Public Health, Nursing, or related field
Technical certification in multiple technologies is desirable
Preferred
Certification in Health Coaching or Clinical Leadership
Familiarity with NCQA, CMS, and other regulatory bodies
Experience with payer-provider collaboration models
Exposure to AI/ML platforms such as Python, R, or cloud-based analytics tools (Azure, AWS, GCP)
Company
AddSource
Welcome to AddSource (DBA name for VeeRteq Solutions Inc.) – Your Trusted Workforce Solution Partner! As a women-owned staffing and HR consulting firm with a robust presence in both Canada and the US, AddSource is dedicated to helping businesses thrive by connecting them with exceptional talent and providing holistic HR solutions.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase