US Healthcare Payor Transformation Lead

Qualifications Strong domain expertise and leadership experience in US Healthcare Payer Techno‑functional understanding of payer lines of business including Medicare, Medicaid, and Commercial Deep understanding of AI‑led transformation possibilities for payers Proven track record of leading end‑to‑end payer transformation programs Demonstrated experience in AI‑led reimagination of payer business (e.g., claims modernization, prior authorization transformation, contact center transformation, clinical transformation, value‑based care) Deep understanding of payer operating model and data flows across claims, provider, membership, and care management Ability to shape transformation vision, define value articulation, and drive execution at scale Strong CXO‑level stakeholder management and advisory experience with US payer clients Knowledge of regulatory mandates and interoperability requirements Roles & Responsibilities Define and lead AI‑led payer transformation vision – Establish forward‑looking transformation strategies for US healthcare payer organizations by reimagining core business processes (claims, prior authorization, provider, member engagement, digital and data) using AI, GenAI, and advanced analytics. Act as a CXO‑level strategic advisor – Engage with senior client stakeholders (COO, CIO, CDO) to shape transformation roadmaps, define value cases, and influence business and technology decisions. Reimagine payer business processes with AI – Identify high‑impact AI/GenAI use cases (e.g., autonomous claims adjudication, intelligent prior authorization, payment integrity, conversational AI for member/provider interactions) and drive their incubation, scaling, and industrialization. AI‑Led Transformation Enablement Partner with delivery and engineering teams to design payer platform modernization strategies (Core Admin Systems, Digital Front Door). Define business‑aligned solution architectures for payer transformation. Business Development Lead large deal pursuits by providing transformative domain‑led solutioning and proposal input. Conduct AI‑led transformation workshops for customers as an industry author. Innovation & Thought Leadership Develop reusable assets: payer domain frameworks, solution accelerators, and reference architecture. Publish white papers, POVs, and internal knowledge artifacts. #J-18808-Ljbffr ClifyX