IT - Consultant | Development process generic | SaaS ...

POC: Bharath Subramanya ATTENTION ALL SUPPLIERSREAD BEFORE SUBMITTING: • UPDATED CONTACT NUMBER and EMAIL ID is a MANDATORY REQUEST from our client for all the submissions • Limited to 2 submission per supplier. Please submit your best. • We prioritize endorsing those with complete and accurate information • Avoid submitting duplicate profiles. We will Reject/Disqualify immediately. • Make sure that candidate's interview schedules are updated. Please inform the candidate to keep their lines open. MANDATORY: Please include in the resume the candidate's complete & updated contact information (Phone number, Email address and Skype ID) as well as a set of 5 interview timeslots over a 72-hour period after submitting the profile when the hiring managers could potentially reach to them. PROFILES WITHOUT THE REQUIRED DETAILS and TIME SLOTS will be REJECTED. Job title: Consultant Work Location: Hartford, CT Vendor Rate: XXX USD per hour Minimum years of experience: 8+ Would you require the candidates to meet you for in person interview? No Is Skype/WebEx interview,OK? OK Is this onsite/remote position: Onsite If onsite, will you be considering relocation candidates: Yes Does this position require Visa independent candidates only? Yes Job Description: The Work stream Leader will provide leadership and operational oversight for the implementation and ongoing operations of client across Claims, Provider, and A&G functions for Medicare Advantage programs serving US health plans. This role will act as the primary client-facing leader, responsible for ensuring seamless delivery of all Claims, Provider, and A&G capabilities, driving regulatory and contractual compliance, and enabling scalable, efficient, and auditable operational processes across the platform. Must Have Skills Lead provider lifecycle management including onboarding, credentialing integration, directory accuracy, network data stewardship, and coordination on provider-related A&G matters. Drive performance monitoring through KPIs, root cause analysis, quality improvements, and corrective action planning across Claims, Provider, and A&G operations. Minimum years of experience 8-10 years Top 3 responsibilities you would expect the Subcon to shoulder and execute Oversee end to end Claims, Provider, and Appeals & Grievances (A&G) operations for Medicare Advantage, ensuring accurate adjudication, pricing, payments, issue resolution, and provider data quality. Serve as the primary client facing leader for all Claims, Provider, and A&G functions delivered through the Infosys Helix platform. Ensure CMS compliance by implementing strong operational controls, monitoring regulatory updates, and maintaining audit ready processes across Claims, Provider, and A&G workflow areas. Nice to have skills Medicare Advantage Claims and Provider operation, CMS Audits Strong analytical and risk-based decision-making skills.

Created: 2026-03-11