Consultant - Healthcare Analytics - Payer

Job Description

Knowledge Preferred / Skills Preferred:The ideal candidate should have knowledge and skill set corresponding to one or more Capability Areas listed below:Capability (EA) Knowledge Skillset :- Digital Strategy - Demonstrates extensive knowledge in helping healthcare payer companies define and evaluate digital and technology strategies and investment portfolios, reflecting market, competitive and other external driversSpecific areas of focus include:- Digital Strategy- CRM Strategy- Technology Strategy- Advanced Analytics Strategy- Working knowledge in one or more of the following healthcare payer domains - Data & Analytics, - Automation, - Artificial Intelligence, - Health Advocacy, - Medical Trend Analysis, - Cost Benchmarking- Ability to identify ongoing digital health trends,evaluate their impact, and develop strategic solutions leveraging these trends- Managing and conducting quantitative and qualitative benchmarking; and secondary analyses of large and complex data- Ability to identify key attributes to be used from vast number of variables, finding patterns &relationships in data- Delivering significant business results that utilizes strategic and creative thinking, problem solving, individual initiative Enterprise Transformation- Experience in delivering core transformation projectssuch as digital transformation, enterprise analytics enablement and cloud migration for healthcarepayers- Considerable experience in Operations Strategy and Transformation, and/or Product Innovation and Development is preferred- Experience with customer segmentation, persona development, journey maps and identifying business and technology capability and solutions needs- Understanding of human-centered design principles- Conducting and managing market research and quantitative and qualitative analyses, including the timely synthesis of complex data into meaningful insights and the ability to readily grasp analytical frameworks and employ them effectively to either qualitative or quantitative evidence- Demonstrates proven thorough knowledge and success supporting large teams through the design and implementation of changes to Operations, including people, process and technology changesSales & Marketing:Optimization :- Conducting Voice of the Customer Analysis, both qualitative and quantitative (surveys, analytics,ethnographic studies and customer journey mapping)- Supporting patient journey maps and building enriched patient experiences- Conducting customer segmentations and segmentation strategies to include utilization of socioeconomic, behavioral or attitudinal, and wants- and-needs based techniques- Developing customer-centric operating models to include Customer Experience Design- Identifying and addressing client needs: building,maintaining, and utilizing networks for relationships- Demonstrating analytical skills using MS Exceland visualization tools such as Tableau / PowerBI is preferred Health Value Management (HVM)- Extensive knowledge of US Healthcare payer middle office capabilities, specifically around - Medical & administrative cost optimization- Claims and payment integrity- Operating model Platform strategy objectives- Utilization management- Care coordination- Applying human centered and Agile principles to Customer Engagement initiatives, sales and marketing processes in a healthcare payer context- Analyzing customer economics, business performance and cost to serve- Supporting one or more project work streams,organizing work to meet time and budget expectations, and keeping project leadership informed of progress and issues- Deliver significant business results that utilize strategic and creative thinking, hypothesis based problem solving, and taking individual initiative- Ability to demonstrate strong business and global acumen by bringing business knowledge, innovation, and a global, cross-cultural mindset- Demonstrating analytical skills using MS Excel and visualization tools such as Tableau / PowerBI is preferredBack Office:Transformation:- Working experience across payer back office(claims, enrollment, billing, membership, provider data, product management, and related functions), specifically to drive growth across operations, IT and - Managing and conducting quantitative and qualitative benchmarking; and primary and secondary analyses of large and complex data- Demonstrates proven thorough knowledge and strategy engagements- Proven experience with either process level familiarity and/or familiarity with the technology solutions that enable these functions- Working experience with claims transaction lifecycles, Healthcare/Payer services products, adjudication engines and COTS platforms- Experience in undertaking operational/performance improvement projects including business process mapping and design, operating model design, project management, benchmarking, technology effectiveness assessments, market strategy, workforce management and IT operating model success supporting large teams through the design and implementation of changes to Operations, including people, process and technology changes- Demonstrating analytical skills using MS Excel and visualization tools such as Tableau / PowerBI is preferred- Knowledge of SAS/SQL and intelligent process automation tools (eg., UIPath, Alteryx) would bean added advantageCorporate / Business Administration :- Understanding of the payer organization structure, industry market trends and industry-leading practices in order to develop insights and provide recommendations- Working knowledge of business strategies; envisioning and prioritizing business capabilities; designing solutions that involve reducing admin costs, managing enterprise performance, creating business and technology implementation road maps; providing business architecture recommendations; and, utilizing tools and techniques to develop and implement project phases- Demonstrates proven thorough knowledge and success supporting large teams through the design and implementation of changes to Operations, including people, process and technology- Identifying and addressing client needs: build relationships; develop an awareness of firm services; communicate in an organized and knowledgeable manner; deliver clear requests for information; demonstrate flexibility in prioritizing and completing tasks; and communicate and manage potential conflicts- Demonstrating analytical skills using MS Excel and visualization tools such as Tableau / PowerBI is preferred- Experience in designing agile solution delivery models including definition of people, process and technology dimensions- Technology Strategy & Planning (i.e. Cloud etc.)- Exposure to data and systems interactions including IT tools and technology- Working knowledge of cloud platforms and the technologies that make them work (for example, AWS, Azure, Google Cloud Platform)- Extensive knowledge of and/or success in professional services or corporate roles, helping companies define and evaluate digital and technology strategies and investment portfolios, reflecting market, competitive and other external drivers- Experience in Payer and healthcare organization IT strategy, architecture, IT excellence, capability, Business/IT alignment and IT operating model - Demonstrating analytical skills using MS Excel and visualization tools such as Tableau / PowerBI is preferred- Knowledge of SAS/SQL and intelligent automation tools (eg., UIPath, Alteryx) would be an added advantageOperating Model - Working experience with Operations and administration of Healthcare/Payer, Product and Services businesses- Participation in the improvement of business processes, change management, leadership excellence, operating model transformation, data and process standardization and development of future state business mode- Payer operations strategy - Sales, Marketing, Benefits/Products, Clinical Management, and Core Operations (Enrollment, Claims, Billing, and Customer Service)- Demonstrating analytical skills using MS Excel and visualization tools such as Tableau / PowerBI is preferredPayer Analytics - Demonstrates extensive knowledge of designing and developing business intelligence (BI) and basic predictive models for data warehouse (DW) information management architecture- Evaluating enterprise data warehouse architecture feasibility, risk and technologies related to business change (i.e. assessing, identifying and recommending BI and related business stakeholders data requirements; BI solution prototyping and development; processes and performance from business and technical standpoints; and the impact of data changes on business and/or IT processes- Working knowledge of Payer and healthcare organization structure, analytics strategy, analytics capability planning, analytics operating model transformation- Demonstrating analytical skills using MS Excel and visualization tools such as Tableau / PowerBI is preferred- Knowledge of SAS/SQL and intelligent automation tools (eg., UIPath, Alteryx) would be an added advantage- Ability to manage and conduct quantitative and qualitative benchmarking; and primary and secondary analyses of large and complex dataProgram Value Realization (PVR)- Extensive knowledge of the Payer and healthcare organization structure- Experience in delivering solutions around complex decision support, program value management, program capability planning and program management,

Keyskills :
product lifecycle managementroad mapsvoice of the customervoice of the customer analysisit strategybusiness process mappingmodel designstrategy to executiondata warehouse architecture