Healthcare Payer Solutions & Lead Pre-Sales BA

Role: Healthcare Payer Solutions and Lead Pre-Sales BA

Experience: 12+ years

Location: Greater Noida, 5 days WFO

Coforge is looking for a seasoned Healthcare Payer Solutions and Pre-Sales BA with strong domain expertise in the U.S. health insurance industry. The ideal candidate will have hands-on experience working with major payers. This role requires a strong understanding of payer operations, including Claims, EDI, Enrollments, Premium Billing, Case management/Prior Authorization, Provider Network, Customer Service, and Payer Data Management.

You will serve as a subject matter expert (SME) during the sales cycle, collaborating with sales, product, and delivery teams to craft compelling solutions that address client pain points and align with their business goals.

Key Responsibilities:

Sales Enablement & Pre-Sales Support

• Partner with sales to develop and deliver solution presentations, work on proposals and give demos as
• Attend discovery sessions with prospective clients to understand their business needs and technical requirements.
• Translate payer workflows into solution blueprints and value propositions.
• Support RFP/RFI responses, proof-of-concept (POC) development, and solution workshops.

Domain Expertise & Thought Leadership

• Serve as a advisor to clients on payer operations, regulatory compliance, and digital transformation.
• Stay current on industry trends, CMS mandates, interoperability standards (e.g., HL7, X12, FHIR), and payer technology ecosystems.

Solution Design & Customization

• Collaborate with engineering and operations teams to align offerings with market needs.
• Design end-to-end solutions across key payer functions: Claims adjudication, EDI transactions, Enrollment & Eligibility, Premium Billing, Customer Service, Case Management/Prior Authorization and Data Analytics.

Required Qualifications:

• 12+ years of experience in the U.S. healthcare payer industry, including direct experience with payers like (e.g., BCBS, Aetna, Cigna).
• Strong knowledge of payer operations: Claims processing, EDI (X12 837/835/270/271), Enrollment, Premium Billing, Case management/Prior Authorization and Customer Service.
• Strong understanding of healthcare data standards and regulatory frameworks (HIPAA, ACA, CMS interoperability rules).
• Excellent communication, presentation, skills.

Preferred Qualifications:

• Experience working with the payer platforms e.g. FACETS, HealthEdge, Custom payer systems
• Familiarity with other technology solutions implemented in Healthcare (Salesforce Health cloud, Vlocity, EDIFECS, CCaaS solution like NICE/Genesys etc.).