To optimize member and provider communications, the full time Healthcare Payer Consultant will serve as a subject matter expert in Utilization Management and Appeals & Grievances, configuring solutions and consulting with clients remotely.
Key responsibilities Serve as a subject matter expert for Utilization Management and Appeals & Grievances workflows within healthcare payer organizations Consult with clients on complex Medicare and commercial letter requirements, including business rules and communication design Manage multiple project timelines while collaborating with offshore teams and cross-functional stakeholders to achieve project objectives Required qualifications Strong experience supporting healthcare payer operations, including Utilization Management and Appeals & Grievances processes Advanced knowledge of QNXT UM and/or A&G; Experience gathering business requirements and translating them into client solutions Working knowledge of XML design and content development Intermediate proficiency with Adobe Illustrator, Photoshop, and InDesign