You are a seasoned Healthcare Payer Solutions and Pre-Sales BA with over 12 years of experience in the U.S. health insurance industry. Your role at Coforge will involve being a subject matter expert (SME) during the sales cycle, collaborating with sales, product, and delivery teams to craft compelling solutions that address client pain points and align with their business goals.

Key Responsibilities:
- Partner with sales to develop and deliver solution presentations, work on proposals, and give demos.
- Attend discovery sessions with prospective clients to understand their business needs and technical requirements.
- Translate payer workflows into solution blueprints and value propositions.
- Support RFP/RFI responses, proof-of-concept (POC) development, and solution workshops.

Domain Expertise & Thought Leadership:
- Serve as an advisor to clients on payer operations, regulatory compliance, and digital transformation.
- Stay current on industry trends, CMS mandates, interoperability standards (e.g., HL7, X12, FHIR), and payer technology ecosystems.

Solution Design & Customization:
- Collaborate with engineering and operations teams to align offerings with market needs.
- Design end-to-end solutions across key payer functions: Claims adjudication, EDI transactions, Enrollment & Eligibility, Premium Billing, Customer Service, Case Management/Prior Authorization, and Data Analytics.

Required Qualifications:
- 12+ years of experience in the U.S. healthcare payer industry, including direct experience with payers like BCBS, Aetna, Cigna.
- Strong knowledge of payer operations: Claims processing, EDI (X12 837/835/270/271), Enrollment, Premium Billing, Case management/Prior Authorization, and Customer Service.
- Strong understanding of healthcare data standards and regulatory frameworks (HIPAA, ACA, CMS interoperability rules).
- Excellent communication and presentation skills.

Preferred Qualifications:
- Experience working with payer platforms like FACETS, HealthEdge, Custom payer systems.
- Familiarity with other technology solutions implemented in Healthcare such as Salesforce Health cloud, Vlocity, EDIFECS, CCaaS solutions like NICE/Genesys, etc. You are a seasoned Healthcare Payer Solutions and Pre-Sales BA with over 12 years of experience in the U.S. health insurance industry. Your role at Coforge will involve being a subject matter expert (SME) during the sales cycle, collaborating with sales, product, and delivery teams to craft compelling solutions that address client pain points and align with their business goals.

Key Responsibilities:
- Partner with sales to develop and deliver solution presentations, work on proposals, and give demos.
- Attend discovery sessions with prospective clients to understand their business needs and technical requirements.
- Translate payer workflows into solution blueprints and value propositions.
- Support RFP/RFI responses, proof-of-concept (POC) development, and solution workshops.

Domain Expertise & Thought Leadership:
- Serve as an advisor to clients on payer operations, regulatory compliance, and digital transformation.
- Stay current on industry trends, CMS mandates, interoperability standards (e.g., HL7, X12, FHIR), and payer technology ecosystems.

Solution Design & Customization:
- Collaborate with engineering and operations teams to align offerings with market needs.
- Design end-to-end solutions across key payer functions: Claims adjudication, EDI transactions, Enrollment & Eligibility, Premium Billing, Customer Service, Case Management/Prior Authorization, and Data Analytics.

Required Qualifications:
- 12+ years of experience in the U.S. healthcare payer industry, including direct experience with payers like BCBS, Aetna, Cigna.
- Strong knowledge of payer operations: Claims processing, EDI (X12 837/835/270/271), Enrollment, Premium Billing, Case management/Prior Authorization, and Customer Service.
- Strong understanding of healthcare data standards and regulatory frameworks (HIPAA, ACA, CMS interoperability rules).
- Excellent communication and presentation skills.

Preferred Qualifications:
- Experience working with payer platforms like FACETS, HealthEdge, Custom payer systems.
- Familiarity with other technology solutions implemented in Healthcare such as Salesforce Health cloud, Vlocity, EDIFECS, CCaaS solutions like NICE/Genesys, etc.