Overview
Skills
Job Details
Role overview:
The consultant must assess existing claims automation processes and provide recommendations to support transformation initiatives. They should have a solid understanding of Agentic AI, HealthRules proficiency, healthcare operations, and regulatory frameworks to help define the future-state Agentic claims transformation model. The consultant should also be able to evaluate and advise on which components are best suited for HRP configurations, RPA, or Agentic AI enablement
Key Responsibilities:
- Analyze and evaluate existing claims automation workflows, systems, and pain points
- Identify opportunities for improvement and optimization within the claims lifecycle
- Develop strategic recommendations to support claims transformation initiatives
- Leverage knowledge of Agentic AI to shape intelligent automation strategies
- Apply expertise in HealthRules (HRP) to configure and align automation with policy and business rules
- Distinguish between use cases best suited for HRP configuration, RPA, and Agentic AI advising stakeholders accordingly
- Collaborate with cross-functional teams (e.g., IT, operations, business) to define the future-state claims model
- Ensure alignment of proposed solutions with regulatory frameworks and healthcare industry standards
- Contribute to roadmap planning, solution design, and implementation of next-gen claims systems
- Communicate complex technical concepts clearly to both technical and non-technical stakeholders