Senior Claims Platform SME – Advisory & Strategy

Remote • Posted 1 hour ago • Updated 1 hour ago

Contract Independent

Contract W2

No Travel Required

Remote

$60 - $70/hr

Fitment

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Job Details

Skills

Gap Analysis
QNXT
Migration
HIPAA
Facets

Summary

Key Responsibilities

Provide strategic advisory on claims platform transformation and modernization initiatives
Lead platform assessments, gap analysis, and optimization roadmaps
Drive end-to-end claims lifecycle improvements (Enrollment, Benefits, Claims, Provider, Payment)
Define enterprise architecture and integration strategy across claims ecosystem
Guide platform migrations and upgrades (Facets/QNXT/HealthEdge/Diamond/Xcelys/ika)
Partner with business leadership to align IT capabilities with payer strategy
Provide SME input for RFP responses, solution architecture, and implementation planning
Identify operational efficiencies, automation opportunities, and cost optimization
Ensure regulatory compliance alignment (CMS, HIPAA, State mandates)
Mentor development and delivery teams on best practices

Required Qualifications

10+ years of experience in Healthcare Payer domain
7+ years hands-on expertise in at least one major claims platform:
- Facets
- QNXT
- HealthEdge (HealthRules)
- Diamond
- Xcelys
- ika
Strong knowledge of claims adjudication workflows
Experience in platform migration or large-scale transformation programs
Proven advisory/consulting background preferred
Strong stakeholder communication and executive presentation skills

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: 91017830
Position Id: 34567
Posted 1 hour ago

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