Engagement Manager

Brief about the role:

Healthcare Finance & Forecasting Consultant (Payer Ops)

Experience: 10-14 years (finance/analytics)

Domain: Payer operations finance forecasting, unit cost modeling, budgeting, and ROI Build the economic backbone for transformation programs. Model unit costs (e.g., cost per claim/appeal), forecast volume/mix, and quantify savings from automation and AI. Partner with product and operations to create defensible business cases and benefits realization.

Key Responsibilities

Financial Modeling & Forecasting

Develop drivers-based forecasts for claims, A&G, enrollment volumes and staffing

Model unit costs: labor minutes, variable non-labor (print/postage), and platform allocations

Business Case & ROI

Quantify automation impacts (minutes saved, FPY lift, re-touch reduction) Create sensitivity scenarios; track actuals vs. plan in a benefits dashboard Data & Analytics

Define telemetry, cost attribution, and allocation methodologies Partner with Data/IT to build reliable data pipelines and BI views

Governance & Reporting

Own monthly/quarterly performance readouts; support audits and compliance reporting Must-Have Qualifications

Payer finance or healthcare analytics experience with strong Excel/SQL/BI

Forecasting/statistics familiarity (time series, regression) and scenario modeling

Ability to tie operational metrics (FPY, SLA, rework) to P&L outcomes

Executive storytelling and stakeholder management

Compliance: Working knowledge of HIPAA Privacy/Security, PHI/PII handling, audit readiness, data governance.

Techno-Functional: Ability to translate business needs into technical designs across cloud, data, APIs, and interoperability.

GenAI/Analytics: Practical experience with GenAI solutioning (e.g., RAG, prompt engineering, evaluation) and classical analytics (segmentation, anomaly detection).

Cloud/Data Tools: Exposure to Azure/AWS/GCP, Snowflake/Databricks/BigQuery, SQL/PySpark, ETL/ELT (ADF/Glue), APIs (REST/GraphQL), Kafka, Tableau, Power BI.

Consulting & BA: Proven proposal/RFP experience, SOW/MSA inputs, stakeholder management, requirements elicitation, UAT planning. Preferred Qualifications

Experience with cloud data warehouses (Snowflake/BigQuery/Databricks) Knowledge of cost accounting and activity-based costing in payer ops Certifications: CFA/FRM (optional), Azure/AWS data certs