HRP Consultant

About the Role

The Healthcare Payor–Provider Domain Functional Lead serves as a strategic subject-matter expert and the vital liaison between business stakeholders and delivery teams. This position is designed to ensure the successful design and execution of complex healthcare solutions across both payer and provider landscapes. The role drives functional strategy, business transformation, regulatory compliance, and operational alignment across end-to-end healthcare workflows.

Success in this role requires a unique dual-perspective: deep experience in healthcare payor domains (claims, enrollment, utilization management, value-based care) and healthcare provider domains (clinical operations, revenue cycle, EHR/EMR). The ideal candidate will translate intricate business needs into scalable functional and technology solutions that bridge the gap between clinical, financial, and operational requirements.

Day in the Life

As a trusted advisor to executive leadership, you will define and own end-to-end business workflows spanning payor–provider interactions. Your day involves leading functional discovery sessions with senior stakeholders to gather requirements, which you will then translate into functional specifications, business rules, and process flows. You will provide thought leadership on industry trends, including value-based care, interoperability (FHIR), and consumer-driven healthcare.

You will partner closely with technology, data, operations, and compliance teams, working alongside architects and developers to ensure functional accuracy. A significant portion of your time will be dedicated to supporting large transformation and modernization programs, identifying risks, and coordinating with change management and training teams to ensure timely delivery with high functional quality.