Pre Sales - Senior Manager Business Solutions - CO - GR - 39595 - 70129 - 1 - Jr168863

Senior Manager Business Solutions

Carelon Global Solutions India is seeking a highly skilled Senior Manager Business Solutions with expertise in developing RFP responses for IT/BPO solution proposals in US Healthcare.

The ideal candidate will play a pivotal role in designing and implementing innovative solutions. The Business Solution architect should have end to end payer value chain understanding, including but not limited to plan/products, member management, provider, claims, finance and utilization management.

He/she will be an essential part of the sales and pre-sales team, responsible for designing and presenting tailored solutions to meet the specific needs of our clients.

The Business Solution architect will be part of commercialization-pre sales team. As part of the Global Commercialization Organization, the candidate will work directly with the Solution Domain Director as a business partner to develop and drive solutions across CGS capability value chain in support of our commercialization strategy.

The candidate on one side will work with sales team for any new opportunity to understand the customer needs and pain points, on another side, candidate will work with Carelon Global solutions (CGS) delivery towers to understand what capabilities CGS has and then stitch a technical and business solution curated as per customer needs and pain points.

This role is a techno functional role and requires a deep understanding of US healthcare payer ecosystem, the ability to translate technical capabilities into business value, and the acumen to engage with clients and stakeholders effectively.

The candidate should have led/participated in medium to large scale solution creations as part of RFP processes.

Job Responsibility

• Lead the design and development of comprehensive solutions for RFP responses, ensuring alignment with business objectives and regulatory requirements.
• Understand and translate client's business requirements into technical & functional solutions in the Healthcare BPO and IT context, with key focus on US Healthcare
• Assist the sales team by establishing technical credibility and qualifying prospects.
• Collaborate with clients to understand their business goals, workflows, and system needs to create and present custom solutions.
• Provide solutions utilize data analytics, identify trends, and provide actionable insights for transformative and continuous improvement as part of overall solution design.
• Own end-to-end RFP response on Functional, Technical and Commercial solution, including leadership of a global Proposal team of Delivery SMEs, Bid Manager, Technical Leads, Pricing, Legal, Creative Services, to strategize, design, document and submit our solution to client.
• Work with sales/presales, delivery, transition, finance and other support functions within organisation to create a compelling solution and value proposition.
• Identify and mitigate solution risks and increase solution effectiveness and efficiency.

Support Pre-Sales and Sales Activities

• Lead RFP / RFI / RFQ response for clients, building a unique value proposition which combines AI, Automation and Client-centric service design, powered by Data and Analytics
• Engage in technical discussions with potential clients, addressing questions, concerns, and technical challenges.
• Conduct feasibility studies, cost-benefit analysis, and ROI calculations to support the sales process.
• Act as a technical liaison between customers, pre-sales, and product managers.
• Conduct Gap Analysis of organization services offerings and solutions and identify potential partners for collaborating to leverage solutions.
• Streamline client responses to be consistent and aligned to CGS's Solutioning and Bidding framework, as necessary.

Healthcare Payer Domain Expertise

• Provide expert insights into the end-to-end healthcare payer ecosystem, but not limited to plan/products, member management, provider, claims, finance and utilization management.
• Provide expert inputs for application development and management and data services related solutioning as and when required basis the RFP scope.
• Client oral presentations: Prepare and deliver oral presentations for prospective clients showcasing the proposed solution and best practices.

Thought Leadership

• Provide thought leadership and contribute to the development of thought papers/whitepapers, case studies, and technical documentation.
• Keep up to date with the latest trends and technologies in Healthcare, HealthTech, claims processing systems, industry trends in Business Process Outsourcing, to design solutions that keep our clients ahead of competition in healthcare transformation and service excellence.

Continuous Value Addition

• Communicate with internal stakeholders on a continuous basis during the lifecycle of a proposal.
• Review overall solution performance based on BAU operations reporting and identify variances and potential causes.
• Understand and document all historic and in-flight transformation initiatives and translate them into opportunities for new customers.
• Identify best practices that can be introduced across clients.
• Provide input to business partners regarding benefits of product/service and analytics.
• Explains timelines and measures of success for implementing these product/service.
• Work together with development teams to consult on enhancements to existing product and development of new solutions based on analytics.
• Review business partner specifications and/or modifications for contracted products and services.
• Analyze business partner data for QA and identification of opportunities for business partners to utilize products and services to improve plan performance.
• Maintain working knowledge of all current systems, products and services and basic understanding of future system and product development plans to allow appropriate level of communication with business partner.

Stakeholder Collaboration

• Work closely with internal and external stakeholders, including healthcare providers, payers, and IT teams, to gather requirements and ensure seamless integration of solutions.
• Work with CGS internal functions across Sales, Delivery, Technology, Legal, Finance, Compliance, etc, to design best-fit solutions that are viable and deliverable.

Estimations & Pricing

Provide leadership around dynamic Estimation and Pricing models that best meet client expectations.

Solution Playbook Creation

Bring in industry best practices, well versed with various solution architect frameworks, (SAM/TAM) and Industry standard operational metrics.

Process Optimization

Lead consultative partnership with clients to map as-is operations, Process Maturity Modelling, Due-diligence Assessment, Customer Journey Mapping and identify process improvement / automation opportunities that result in reducing operational cost and enhancing end-customer experience.

Regulatory Compliance

Ensure all solutions comply with relevant healthcare regulations and standards, such as HIPAA and ICD-10.

Documentation

Create detailed documentation, including solution design specifications, process flows, and user manuals.

Training and Support

Mentor and train the team members part of pre-sales team and delivery tower SMEs on solution design, industry best practices and how to create customer centric proposals.

Qualification

• Bachelor's degree in Healthcare Management, Information Technology, Business Administration, or a related field. Advanced degree preferred.
• Strong understanding of healthcare regulations, coding standards (ICD-10, CPT), and industry best practices. HIPAA, PAHM, FAHM certifications will be highly desirable.
• Certifications like TOGAF, Cloud Certified Solution Architect, Agile & Design Thinking Practitioner etc., can be an advantage.

Experience

• Minimum of 15+ years of experience in healthcare claims processing and solution design.
• Significant experience in developing, selling, and delivering healthcare IT and BPO solutions.
• 10+ years experience in a pre-sales or technical sales role is highly desirable.
• Well Versed in Estimation, Staffing and Transition models with deal sizes > $1 Million ACV
• Should have in-depth understanding of the delivery operation, and all processes necessary to deliver the solution
• Demonstrated relevant experience defining, developing, and executing customer services strategies, operations and action plans
• RFP/RFI contributions: Candidate should have history of leading/contribution to large and complex RFP/RFIs. The candidate must maintain focus and exhibit versatility as a collaborative team member, particularly in high-pressure situations.
• US healthcare domain knowledge: Exhibits strong strategic thinking and adept people management skills. Possesses a comprehensive understanding of healthcare domains, including claims, members, and providers