We are looking for an experienced Healthcare Product & Domain Specialist with 10–15 years of payer IT experience to drive AI-led digital transformation across Value-Based Care, Claims, Authorization, and Payment Integrity.
Key Responsibilities:
- Define product features and workflows across VBC, Claims, Authorization, and Payment Integrity.
- Create journey maps, wireframes, and rapid prototypes using AI-powered design tools.
- Lead requirements discovery and convert payer needs into clear specs and process flows.
- Model end-to-end workflows and ensure interoperability with FHIR, HL7, and X12 standards.
- Work with engineering teams to translate requirements into APIs, data schemas, and microservices.
- Collaborate with AI teams to integrate LLM/RAG use cases like claims triage or pre-auth summarization.
- Support client workshops, RFP responses, demos, and solution pitching.
- Build reusable domain assets, accelerators, and visual artifacts for future implementations.
- Mentor junior analysts and keep product direction aligned with regulatory and market trends.
- Participate in sprints, backlog grooming, and validation activities to ensure smooth delivery.
Preferred Skills:
- Strong domain knowledge in VBC, Claims, Payment Integrity, or Authorization.
- Hands-on experience with FHIR, HL7, X12, and payer interoperability standards.
- Proficiency in wireframing tools (Figma, Miro, Uizard) and AI-driven design platforms.
- Ability to write clear process flows, business rules, KPIs, and integration specs.
- Basic understanding of SQL, APIs, JSON, and healthcare data models.
- Experience working closely with product, engineering, and AI teams.
- Strong communication, presentation, and storytelling skills.
- Agile mindset with the ability to operate in fast, multi-role environments.
- Certifications like CSPO, CBAP, or FHIR/HL7 are a plus.
