Senior Manager – GenAI, Healthcare Claims
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Job Description
Senior Manager/Associate Director focusing on AI solutions for Medicare and Medicaid claims processes. Collaborating with clients on evaluation, design, and knowledge management.
Responsibilities:
- Requirement gathering - Work closely with clients and business SMEs to analyze pain points in the Medicare and Medicaid processes (with greater focus on claims management) and provide detailed information on business procedures, industry regulations, and user needs.
- Evaluation and recommendation of use-cases - Evaluate and recommend AI, analytics, software, and engineering use cases to address client challenges with regards to complex business logics and user workflows.
- Solution design - Provide critical insights and guidance to project teams, ensuring that the solution accurately reflects the complexities and nuances of Medicare and Medicaid domain (specifically focused on claims management), when developing products, systems, or processes. Partner with analytics and technology consulting teams to share insights on key processes, personas, and tools, ensuring alignment on effective solutions.
- Validation and Review - Assess project deliverables, design documents, and test cases to ensure they align with domain knowledge and industry best practices.
- Training and Knowledge management - Educate project teams on Medicare/Medicaid domain-specific concepts, jargon, and industry standards. Support the development of capability assets (including documents, demos) for the Medicare & Medicaid LOB within Tiger’s Consulting, DS, and Engineering Practice.
Requirements:
- 10-12 years of deep domain consulting experience.
- Extensive understanding of US healthcare claims and Medicare and Medicaid industry and its specific regulations.
- Chatbot/GenAI solution implementation for claims configuration.
- Handling MBR, QBR, estimation process involving budget, Production support.
- Excellent analytical skills to identify potential issues and propose solutions by effectively conveying technical information to diverse teams.
- Excellent problem solving and critical thinking skills with diligence.
- Experience with managing stakeholder expectations to ensure effective communication and program success.
- Ability to stay updated on industry trends and emerging technologies.
- Masters/Bachelor of Science/Engineering, MBA preferred.
- Healthcare certifications preferred.
Benefits:
- Significant career development opportunities exist as the company grows. The position offers a unique opportunity to be part of a small, fast-growing, challenging, and entrepreneurial environment, with a high degree of individual responsibility.
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