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Healthcare Payer SME

• Posted 1 day ago • Updated 7 hours ago

Contract Corp To Corp

ADDSOURCE

Fitment

Dice Job Match Score™

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Job Details

Skills

Business Requirements
Content Management
regression testing
data quality
Data Validation
Governance
gap analysis
User Experience
Regulatory Compliance
Medicare
Systems Analysis
Medicaid
Public Health
Networking Skills
User Stories
Coordination Skills
SQL Databases
Delivery of Projects
Regulatory Requirements
Health Care
Scrum Methodology
Business Processes
Digitisation
Information Engineering
Acceptance Testing
Health Insurance Portability and Accountability Act Compliance
Requirements Traceability
Business Process Mapping
Insurance Claim Processing
Backlogs
Mobile Application Software
Standards for Accessibility
Drug Authorization
Health Administration
Business Workflow Analysis
Consumer Engagement
Nursing

Business Requirements
Content Management
regression testing
data quality
Data Validation
Governance
gap analysis
User Experience
Regulatory Compliance
Medicare
Systems Analysis
Medicaid
Public Health
Networking Skills
User Stories
Coordination Skills
SQL Databases
Delivery of Projects
Regulatory Requirements
Health Care
Scrum Methodology
Business Processes
Digitisation
Information Engineering
Acceptance Testing
Health Insurance Portability and Accountability Act Compliance
Requirements Traceability
Business Process Mapping
Insurance Claim Processing
Backlogs
Mobile Application Software
Standards for Accessibility
Drug Authorization
Health Administration
Business Workflow Analysis
Consumer Engagement
Nursing

Summary

Role: Senior Healthcare Payer SME

As a Senior Healthcare Payer SME with healthcare payer experience you'll support member portals, mobile apps, and digital self-service platforms. The role focuses on gathering requirements, improving member experience, analyzing healthcare data, and delivering solutions supporting Medicaid, Medicare, claims, enrollment, and provider operations.

Location: Remote (EST) USA

Experience: Min 10+ Yrs.

Duties:

Serve as SME for member portal, mobile app, and digital member experience platforms.
Gather and document business requirements, user stories, and acceptance criteria.
Lead enhancements for eligibility, benefits, claims, provider search, PCP selection, ID cards, prior authorizations, and wellness programs.
Conduct gap analysis, process mapping, workflow analysis, and requirements traceability.
Perform SQL-based data validation for eligibility, enrollment, provider, and claims data.
Partner with data engineering, IT, product, and business teams to ensure data accuracy and system functionality.
Facilitate stakeholder meetings and act as liaison between business and technical teams.
Support Agile delivery, backlog refinement, sprint planning, and prioritization.
Coordinate UAT, regression testing, and release validation activities.
Ensure compliance with HIPAA, CMS, Medicaid, and other regulatory requirements.

Required:

Bachelor's or master's degree in healthcare administration, Public Health, Nursing, or related field.
Min 10+ years of healthcare payer experience in business/system analysis roles
Strong understanding of Medicaid, Medicare and commercial plan operations
Familiarity with member portals and digital health engagement platforms.
Strong experience producing BRDs, FRDs, user stories, STTMs, business process maps, and gap analyses.

Desired:

Experience with healthcare consumer engagement platforms.
Knowledge of UX/UI and accessibility standards.
Experience with digital transformation initiatives.
Prior payer member experience projects.
Exposure to healthcare compliance and governance programs.

VeeRteq Solutions is an Equal Opportunity Employer

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 91122967
Position Id: 2026-4425
Posted 1 day ago

Company Info

About ADDSOURCE

AddSource is a premier staffing and workforce solutions partner headquartered in Delaware, USA, with operations in Alberta, Canada under the brand name AddSource.

We specialize in connecting top-tier talent with leading organizations across diverse industry sectors.

With a strong commitment to excellence, our mission is to deliver innovative, customized staffing solutions that empower clients to achieve their goals while helping candidates advance their careers.

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