12-16 years experience in the Health Insurance(Payer) domain
Prior experience working in a Payer organization will be strongly preferred (Or should have worked in a leading IT organization as a Domain SME)
Deep knowledge of processes like member enrolment, eligibility verification, claims adjudication, underwriting, payments, medical coding, billing, denial management etc. along with knowledge of IT products/solutions used in the Health Insurance workflow is a must
Awareness of trends in Health Insurance for the USA geography is desirable (e.g. Obamacare legislation's, HITECH/ARRA, HIPAA, Meaningful Use, changes in Medicare/ Medicaid etc.)
Proven experience planning, designing, and implementing mid/ large scale business-IT solutions in the Payer environment
Certifications in Insurance or in the IT field would be an advantage
Exceptional communication and interpersonal and client-facing skills.
Strong leadership skills, decision making and problem solving abilities.
BS and/or MS in computer science or equivalent experience.