Healthcare Consulting - GO/JC/4791/2026

• Job Details

Job Title: Healthcare Consulting

Job Location: Bangalore/Hyderabad/Chennai/Pune/Mumbai /Noida/Kolkata

Work Model: Hybrid

• Candidate Expectations

Total Experience and Relevant Experience – 6+Years

Candidate Location : Bangalore/Hyderabad/Chennai/Pune/Mumbai /Noida/Kolkata

Skills – HIPAA, Medicare/Medicaid guidelines

Candidate Industry (BPO / KPO / GBS / GCC / GSS / Captive Shared Services)

Diversity – N/A

• Education and Certification

Qualification: Mandatory: B.Tech /B.E /BDS and Good to Have : MBA (Fulltime)

Specific Remarks: Distance education not accepted, 15 years regular stream mandatory, etc.

• Detailed Job Description

Key Responsibilities

• Domain Expertise: Serve as a Subject Matter Expert (SME) in one or more areas: Claims Adjudication, Membership/Enrolment, Utilization Management (UM), Prior Authorization, or Revenue Cycle Management (RCM). Recommend solutions for Value-based care, HEDIS/STAR rating improvements, and digital transformation
• Regulatory Compliance: Ensure deliverables adhere to HIPAA, Medicare/Medicaid guidelines, and federal/state-specific regulations
• Product Management: Define and communicate product vision and strategy, manage backlogs (Jira/ADO, Rally), and translate complex clinical/business needs into actionable requirements
• Stakeholder Collaboration: Engage with internal and external stakeholders, including clients, consultants, and technology teams, to gather requirements and feedback.
• Performance Monitoring: Monitor and analyze product performance metrics and risks, using data-driven insights to drive continuous improvement.
• Market Trends: Stay informed about industry trends, emerging technologies, and best practices to ensure the product remains competitive and innovative.
• Experience:
• 6+ years of experience in healthcare domain as a Consultant, Product Owner, or similar role in a technology-focused environment.
• Must have US related healthcare experience in areas such as Medicare, Medicaid, Duals, Claims, Enrolment, Encounters, Interoperability, PBM, Providers etc.
• Understanding of Solution architecture, EDI transactions, HL7 and FHIR standards
• Experience working with Agile/Scrum methodologies and tools.
• Key Skills Mandatory Key Skills: Must have US related healthcare experience in areas such as Medicare, Medicaid, Duals, Claims, Enrolment, Encounters, Interoperability, PBM, Providers, Claims Adjudication, Membership/Enrolment, Utilization Management (UM), Prior Authorization, or Revenue Cycle Management (RCM). Recommend solutions for Value-based care, HEDIS/STAR rating improvements, and digital transformation etc.
• Good to Have Skills: Understanding of Solution architecture, EDI transactions, HL7 and FHIR standards