Director for Medicaid BPaaS (Products & Solutions)

Job Description

Key responsibilities:

About BPaaS: BPaaS (Business Process as a Service) is a platform based service broadly addressing scope under payer core administration – enrollment, billing, claims, encounters, provider calls, member calls, intake of UM requests, A&G Intake, comprehensive reporting (Operational reporting, compliance reporting and SLA reporting), supporting client’s audit and compliance requirements etc. The underlying platform in Cognizant BPaaS solution is based on TriZetto core products along with surround 3^rd party products. Cognizant delivers business operations under Global Delivery structure from delivery centers in North America, Philippines and India.

Cognizant’s BPaaS solutions are constantly evolving to address expanded scope in the middle and the front office, with new services in 2020 and 2021 will have Provider credentialing services, Medical Management services, Quality as a Service etc. Cognizant’s BPaaS model leverages standardization and productization of services to build scale and have predictable outcomes.

Director for Medicaid BPaaS Products and Solutions, will be responsible for all Medicaid BPaaS product development and client solutions (in pre-sales stages), and enable / establish an oversight in client implementations in post-sales stage. The role requires working with cross functional teams to deliver the following:

1. Product Development

a. Conceptualization of end to end BPaaS scope in various programs under Medicaid

b. Standardization of processes and enabling teams to build “spec house” to leverage commonality across States

c. Working with Compliance on documenting State requirements for Healthplans

d. Act as business user group for the IT implementation team delivering the platform, as a reusable “minimal standard product”

2. BPaaS Solutions

a. Work with client facing teams on RFP’s for Medicaid BPaaS

b. Review RFP requirements and do gap analysis with Product

c. Create delivery plan for overall solution

d. Perform bid defense and client presentations

3. Enable Client Onboarding

a. Work with delivery teams to successfully implement and onboard client’s services on Medicaid BPaaS

b. Lead as SME to prioritize and plan onboarding activities between Product team, customizations offered in solution and requirements obtained during execution

c. Enable operations team to take over services

4. Product Management

a. Maintain roadmap including technical and functional upgrades

b. Work with IT teams on enriching the platform, while maintaining standardization

c. Pro-actively plan for changing compliance needs, working with Cognizant’s Govt BPaaS Compliance teams

d. Process feedbacks from Clients, internal delivery teams (business operations, compliance and IT) to bring in product innovations for improving CSAT and Net Promoter scores

e. Take cost of delivery feedbacks and compare with modeled costs for refining product parameters

The role is client facing and may require moderate traveling. The performance objectives may contain combination of project delivery for which candidate has the oversight, revenue and new contract signings (measured in terms of TCV), and other goals aligned to Product Life Cycle Management.

1. Extensive knowledge of healthcare operations focused on Medicaid plans.

2. At least 15 years of multi-function experience in TPA / Healthplan core back-office operations catering to different Medicaid plans. (Preferred State – Texas)

3. Candidate should have been part of a few Medicaid platform implementations, both as business contributor as well as a leader

4. People Management: Apart from leading direct teams, candidate should have strong credentials in working and leading teams in matrixed organizations; specifically working with IT teams and third party vendors

5. Revenue and Cost management, P&L Management and demonstrated ability to lead innovation delivering improved outcomes

6. Bachelors or higher degree preferably in Business Administration and/or in Operations