Healthcare Consulting - GO/JC/4791/2026

Job Details

Job Title: Healthcare ConsultingJob Location: Bangalore/Hyderabad/Chennai/Pune/Mumbai /Noida/KolkataWork Model: Hybrid Candidate ExpectationsTotal Experience and Relevant Experience – 6+YearsCandidate Location : Bangalore/Hyderabad/Chennai/Pune/Mumbai /Noida/KolkataSkills – HIPAA, Medicare/Medicaid guidelinesCandidate Industry (BPO / KPO / GBS / GCC / GSS / Captive Shared Services)Diversity – N/A Education and CertificationQualification: 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 DescriptionKey ResponsibilitiesDomain 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 transformationRegulatory Compliance: Ensure deliverables adhere to HIPAA, Medicare/Medicaid guidelines, and federal/state-specific regulationsProduct Management: Define and communicate product vision and strategy, manage backlogs (Jira/ADO, Rally), and translate complex clinical/business needs into actionable requirementsStakeholder 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 standardsExperience 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