About this role
Lead payment integrity (PI) transformation strategy for new payer prospects by developing the business case, supporting executive conversations, and managing proposal execution. Serve as Cohere SME to demonstrate platform value, quantify savings, and ensure requirements translate into statements of work and implementation plans.
Key Responsibilities
- Become an expert in market and technology trends impacting payment integrity and claim adjudication
- Engage payer executives as a thought partner and sales call SME
- Lead consultative process to develop PI transformation strategy and business case
- Project manage cross-functional proposal and pricing process and ensure client buy-in
- Draft statements of work and partner with solution architecture and implementation teams to translate requirements into build plan
Technical Overview
This role is heavily consultative and solution-oriented for healthcare payers, covering PI transformation, claim adjudication, utilization management, value-based care, and interoperability topics. The work includes coordinating cross-functional proposal/pricing, drafting statements of work, and aligning solution architecture and implementation teams to deliver a coherent build plan based on client requirements.
Ideal Candidate
The ideal candidate is a senior payment integrity strategist who can lead consultative, executive-facing selling to payer organizations and drive PI transformation business case development. They are comfortable acting as a subject matter expert on sales calls, leading demonstrations, managing cross-functional proposal/pricing processes, and translating client requirements into proposals, statements of work, and implementation plans.
Must-Have Skills
Quickly developing a deep understanding of customers' needs and Cohere's platformLead consultative process to help prospects develop the strategy and business case for PI transformationServe as Cohere SME on sales calls with payer executivesLead demonstrations and speak to value and differentiation of the Cohere platformCollaborate with productselectionsoperationsand integrations team to recommend Cohere solutionsDraft statements of work that reflect client requirements and Cohere capabilitiesPrepare executive presentations for prospective customersProject manage cross-functional proposal/pricing processEnsure client buy-in and internal sign-off on proposal documents
Required Skills
Payment integrityPI transformationclaim adjudicationutilization managementvalue-based careinteroperabilitybusiness case developmentsales calls with payer executivesplatform demonstrationsproposalsstatements of workexecutive presentationssavings quantificationcross-functional proposal/pricing processcompliance needssolution architectureimplementation teamsrequirement translation into build planthought leadership contentscalable sales model
Hard Skills
Payment integrityPI transformationClaim adjudicationUtilization managementValue-based careInteroperabilityThought leadership contentBusiness case developmentEnterprise software partnership salesSales calls with payer executivesPlatform demonstrationsReimbursementClinical expertiseTechnology aspectsProposal developmentStatements of workProject managementCross-functional proposal/pricing processSavings quantificationRequirements gatheringCompliance needsDrafting statements of workRequirement translation into build planExecutive presentationsSales growth function participationInternal process improvementScalable sales model
Soft Skills
Thought partner advisoryConsultative sellingClient executive engagementCreative problem-solvingAnalytical skillsInfluence as glue between commercial and operational functionsCross-functional collaborationStakeholder managementProject management leadershipCustomer relationship management
Keywords for Your Resume
Senior Payment Solutions Managerpayment integritypayment integrity strategistpayment accuracyclinical excellencehealthcare operational efficienciesPI transformationclaim adjudicationutilization managementvalue-based careinteroperabilitypayer executivessales callsdemonstrationsbusiness casereimbursementclinicaltechnologyenterprise software partnershipsproposalsstatements of workSOWcross-functional proposal / pricing processexecutive presentationssavings quantificationsolution architectureimplementation teamsbuild planthought leadership contentgrowth functionscalable sales modelcompliance needsintegrations teambusiness case developmentproposal/pricing process
Deal Breakers
Must demonstrate the ability to lead consultative business case development for payment integrity (PI) transformation, Must be able to support sales calls with payer executives including leading demonstrations, Must have experience drafting statements of work and managing cross-functional proposal/pricing processes
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