Payer Modernization Strategist SME

We are seeking a versatile and highly experienced Payer Modernization Strategist SME to join our Healthcare and Life Science (HCLS) team. As a Payer Modernization SME, you will serve as a trusted advisor to clients, helping them navigate modernization initiatives including AI, regulatory compliance, and market-driven transformation. You will understand and help translate complex mandates into actionable strategies, ensuring payer systems (claims, benefits, provider networks, contracting, wellness, etc.) work together seamlessly while minimizing disruption to organizational processes and member experiences.

This role is multi-faceted, you will lead strategic engagements, support delivery teams, contribute to thought leadership, and partner with sales to shape client pursuits. Strong communication and presentation skills are essential, as you will interact with stakeholders ranging from business owners to executives.

Perficient is the global AI-first consultancy. Our team of strategists, designers, technologists, and engineers partners with the world’s most innovative enterprises and admired brands to deliver real business results through the transformative power of AI. As part of our AI-First strategy, we empower every employee to build AI fluency and actively engage with AI tools to drive innovation and efficiency. We break boundaries, obsess over outcomes, and shape the future for our clients. Join a company where bold ideas and brilliant minds converge to redefine what’s possible - while building a career filled with growth, balance, and purpose. 

Strategic Advisory

• Guide payers through modernization trends and interoperability requirements, including AI.
• Translate regulatory and market changes into clear implications and options for clients.

Mandates & Compliance

• Maintain expertise in federal and state programs impacting payers (e.g., CMS Interoperability, Prior Authorization).
• Advise clients on compliance strategies and help internal teams understand regulatory demands.

Sales & Business Development

• Partner with account teams to shape proposals, respond to RFPs, and represent SME expertise in client meetings.
• Contribute to solution narratives, scoping, and estimates for engagements.

Project Delivery

• Serve as domain lead on payer-focused projects, ensuring scope and deliverables align with industry best practices.
• Collaborate with project managers and technical experts to implement solutions that address regulatory and market changes.

Thought Leadership & Client Education

• Develop client-facing presentations, playbooks, and training sessions on compliance, interoperability, and modernization.
• Contribute to white papers, webinars, and conference content to showcase industry expertise.

• 8–12+ years of experience in healthcare consulting, payer strategy, or enterprise system implementations.
• Demonstrated success leading strategic initiatives and supporting sales/RFP efforts.
• Hands-on experience with implementation of key payer systems (claims, benefits, prior authorization, care management).
• Experience advising leadership on regulatory mandates and market conditions and impact to stakeholders.
• Strong experience with payer systems and processes across functional areas (claims, benefits, provider networks, contracting, wellness, etc.).
• Expertise in system integration, interoperability, and data flow across payer platforms.
• Proven experience responding to regulatory changes such as CMS Interoperability and Prior Authorization rules.
• Knowledge of healthcare policy and regulatory topics impacting payer operations.
• Proficient in leveraging AI technologies to drive innovation, support strategic initiatives, and enable data-driven decision-making. 
• Possesses a strong understanding of AI capabilities, limitations, and ethical considerations. 
• Exceptional communication skills; able to simplify complex regulations for executive audiences.
• Strategic thinker with the ability to frame problems, options, and trade-offs.
• Credible presence with senior payer leaders; able to influence and build consensus.
• Collaborative, low-ego style; effective in cross-functional teams.
• Comfortable working in dynamic environments with multiple clients and initiatives.
• Bachelor’s degree in healthcare, business, technology or related fields (masters preferred).
• Expectation for some travel and local office on-site may be required (depending on location and requirements).

Perficient, Inc. proudly provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, r