Subject Matter Expert - US Health Insurance

Company Overview 

10Pearls is an end-to-end digital technology services partner helping businesses utilize technology as a competitive advantage. We help our customers digitalize their existing business, build innovative new products, and augment their existing teams with high-performance team members. Our broad expertise in product management, user experience/design, cloud architecture, software development, data insights and intelligence, cyber security, emerging tech, and quality assurance ensures that we are delivering solutions that address business needs. 10Pearls is proud to have a diverse clientele including large enterprises, SMBs, and high-growth startups. We work with clients across industries, including healthcare/life sciences, education, energy, communications/media, financial services, and hi-tech. Our many long-term, successful partnerships are built upon trust, integrity, and successful delivery and execution.

Role

We are seeking an experienced USA Health Insurance Subject Matter Expert (SME) to join our software development team. This role involves leveraging domain expertise to analyze requirements, optimize processes, and collaborate with cross-functional teams to drive successful implementations in the health insurance domain. 

Responsibilities

• Collaborate with stakeholders to gather, analyze, and document requirements. 
• Translate business needs into functional and technical specifications. 
• Provide deep insights into U.S. health insurance processes, including claims processing, policy administration, member engagement, and regulatory compliance. 
• Identify opportunities for process optimization and propose efficient solutions. 
• Validate solutions during development and testing phases, ensuring alignment with requirements. 
• Facilitate communication and alignment between business and technical teams. 
• Create detailed documentation, including use cases, user stories, and process flows. 

Requirements

• Extensive knowledge of U.S. health insurance, including claims processing, benefits administration, provider networks, member enrollment, and compliance (ACA, HIPAA, CMS guidelines, etc.). 
• Solid experience within the USA health insurance domain. 
• Strong analytical and problem-solving skills for evaluating complex systems and workflows. 
• Excellent communication skills to engage both technical and non-technical stakeholders. 
• Proficiency in tools such as JIRA, Confluence, Visio, or similar platforms. 

Preferred Skills

Experience with Salesforce Health Cloud.