Healthcare Payer Automation Consultant

About Genzeon

Delivering excellence in IT services and solutions for the retail and healthcare sectors. Genzeon is a leading provider of intelligent automation, security, compliance, cloud, and managed services. Our healthcare capabilities integrate data systems, facilitate information flow, and leverage interoperability to improve clinical and operational outcomes. Genzeon empowers retail enterprises with multichannel IT solutions that deliver a personalized experience for consumers.

Genzeon has an exciting opening for Healthcare Payer Automation Consultant to join our team.

Healthcare Payer Automation Consultant

Contract

Remote

Position Overview

We are seeking an experienced Healthcare Payer Automation Consultant to provide strategic advisory services to our clients. The consultant will assess, recommend, and guide automation initiatives across healthcare payer operations, with particular focus on STAR ratings, HEDIS reporting, and Prior Authorization processes. This role requires a strategic mindset to help clients identify automation opportunities, develop roadmaps, and achieve operational excellence through technology transformation.

Consulting Services Scope

• Strategic assessment of clients' current payer operations and automation maturity

• Development of automation strategy and roadmap tailored to client needs

• Advisory services for HEDIS reporting optimization and STAR ratings improvement

• Process reengineering recommendations for Prior Authorization workflows

• ROI analysis and business case development for automation initiatives

• Best practices guidance for healthcare quality metrics and reporting

• Change management and stakeholder alignment support

Key Deliverables

• Automation opportunity assessments and gap analysis reports

• Strategic roadmaps and implementation plans

• ROI and business case documentation

• Process optimization recommendations

• Technology solution evaluations

• Best practices documentation and training materials

• Performance benchmark reports and industry insights

• Change management and communication plans

Required Qualifications

• Bachelor's degree in Healthcare Administration, Information Technology, or related field.

• 10+ years of experience in healthcare payer operations.

• 10+ years of consulting experience in healthcare process automation.

• Deep understanding of HEDIS measures, STAR ratings, and quality improvement programs.

• Deep understanding of Prior Authorization processes (both clinical and non-Clinical processes).

• Proven track record of successful automation advisory projects.

• Strong knowledge of healthcare industry metrics and benchmarks.

• Experience in strategic planning and roadmap development.

Preferred Qualifications

• Master's degree in Healthcare Administration or related field.

• HEDIS Compliance Certification.

• Healthcare-specific consulting experience with top-tier consulting firms.

• Experience with major RPA platforms and automation technologies.

• Knowledge of healthcare regulatory requirements and compliance.

• Six Sigma or PMP certification.

Expertise Areas

• Healthcare payer operations and workflows.

• Quality metrics and reporting systems.

• Process automation technologies and trends.

• Healthcare analytics and data integration.

• Industry benchmarking and best practices.

• Change management and stakeholder engagement.

• ROI analysis and business case development.

Key Competencies

• Strategic thinking and vision development.

• Executive-level communication and presentation skills.

• Client relationship management.

• Problem-solving and analytical capabilities.

• Project and program management.

• Industry thought leadership.

• Workshop facilitation and training.

Additional Requirements

• Ability to work independently and manage multiple client engagements.

• Flexibility to adapt consulting approach to different client environments.

• Strong executive presence and ability to influence decision-makers.

• Capability to develop and deliver client presentations and workshops.

• Professional network within the healthcare payer industry.

Apply Job!