Principal Consultant Healthcare Payer

Principal Consultant Healthcare Payer
Location: California, USA | No immigration sponsorship available

Overview:
We are seeking a senior AI leader with deep expertise in healthcare payer operations to lead transformative AI and GenAI engagements. This role blends strategic consulting, AI solution delivery, and thought leadership, with a focus on improving care delivery, reducing costs, and enhancing member engagement for healthcare organizations.

Key Responsibilities:

• Lead end-to-end AI/GenAI consulting engagements for healthcare organizations.

• Develop and deploy GenAI-powered solutions for member engagement, care management, risk adjustment, and fraud detection.

• Build proprietary AI frameworks (LLMs, RAG, agentic workflows) and oversee governance models.

• Collaborate with cross-functional teams to build MVPs and scalable AI solutions.

• Cultivate executive relationships and deliver business development and thought leadership collateral.

Qualifications:

• 12+ years in healthcare consulting/technology delivery; 5+ years in AI/GenAI roles.

• Strong understanding of healthcare payer ecosystem (commercial, Medicare, Medicaid) and associated data systems (claims, EMR, HEDIS).

• Hands-on experience with LLMs, NLP/NLU, cloud platforms (AWS, Azure, Google Cloud Platform), and MLOps.

• Knowledge of HIPAA, responsible AI, and regulatory compliance.

• Bachelor s in CS, Engineering, Data Science, or Healthcare Administration (Master s/MBA preferred).

Nice-to-Have:

• Experience with OpenAI, Anthropic, Vertex AI, Bedrock.

• Familiarity with FHIR/HL7 interoperability standards.

• Prior experience in AI product development or commercialization.