Amtex Systems Inc is an information technology and talent solutions company offering talent and BI consulting to the companies in US for over 25 years.
Our solutions are designed to fill resource gaps, by providing the right candidates who deliver value to the organization. Our propensity to nurture and build strong relationships with our clients helps us better understand their business demands and gives us the ability to provide services that are on time and rise above the rest.
Senior Consultant, Health Plan Business Relationship & Technology Management
Right to Hire. 3 days a week in the office.
Only Locals to NY
The ideal candidate understands payer operations and has enough HealthEdge/HealthRules Payer and GuidingCare knowledge to be credible with both business and technology stakeholders. However, the most important capability is executive presence and relationship management.
This person should be able to sit with a Health Plan executive, understand the business concern, translate it for IT, bring the right people together, drive decisions and follow-through, and provide clear executive communication without needing to personally manage every underlying workstream.
This individual will act as the primary liaison between Health Plan business leadership, IT leadership, product/platform teams, and delivery teams, with particular emphasis on the Health Payer ecosystem, HealthEdge/HealthRules Payer (HRP) and GuidingCare (GC).
The ideal candidate combines three capabilities:
- Health Plan domain knowledge with a strong understanding of payer operations and terminology.
- Health Plan technology knowledge, particularly HealthEdge/HealthRules Payer and GuidingCare.
- Executive relationship management, with exceptional communication, presentation, facilitation, and stakeholder-management skills.
Required Qualifications
- 10+ years of experience in healthcare IT, payer technology, technical program management, business relationship management, product/program leadership, or a comparable role.
- Significant experience working within the health insurance / healthcare payer environment.
- Strong understanding of payer business processes and enterprise technology ecosystems.
- Working knowledge of HealthEdge/HealthRules Payer (HRP) and/or GuidingCare, with preference for candidates familiar with both.
- Demonstrated experience working directly with VP, SVP, EVP, CIO/CTO-level or comparable senior leadership.
- Excellent executive communication and presentation skills.
- Strong facilitation, negotiation, relationship-management, and conflict-resolution skills.
- Ability to translate complex business and technical topics into concise executive-level communication.
- Experience coordinating large, cross-functional technology initiatives involving business, IT, vendors, and platform partners.
- Ability to operate effectively in an environment with competing priorities, multiple initiatives, and complex dependencies.
Preferred Qualifications
- Experience with HealthEdge implementations, transformations, conversions, or major enhancement programs.
- Experience with GuidingCare or comparable care management/utilization management platforms.
- Experience operating in a BRM, TPM, program leadership, or technology relationship-management capacity within a health plan.
- Familiarity with payer functions such as claims, enrollment, provider, utilization management, care management, member services, and related operations.
- Experience working with large enterprise implementations and third-party technology vendors.
