Senior Provider Data Management Technical / Domain SME
We are seeking a Senior Technical Professional with 12 15 years of experience who brings a strong combination of healthcare provider-domain expertise and hands-on technical/application integration experience. The ideal candidate must understand Provider Data Management (PDM), Provider Network and Contracts, credentialing, and healthcare payer operations, while also being capable of working deeply with APIs, integrations, data, rules engines, workflows, and application configurations.
This is a hybrid provider-domain and technical role. The candidate should be able to translate provider business and operational requirements into scalable technical solutions, troubleshoot complex provider data and integration issues, and work effectively with both business/domain stakeholders and technical teams.
Key Areas of Experience
Provider Data Management (PDM) and Provider Network/Contracts
Provider onboarding, credentialing, contracting, and network management
Strong understanding of healthcare payer systems and provider lifecycle processes
REST/SOAP APIs, ETL, and application/system integrations
SQL and hands-on provider data analysis and troubleshooting
Rules engines such as Drools/Kogito
Provider data quality, Master Data Management (MDM), match/merge, and data governance
Workflow/BPM configuration and business process automation
CI/CD and application configuration promotion across environments
Integration with Claims, Provider Directory, Provider Portal, and other payer applications
Ability to analyze and resolve issues spanning provider data, business rules, workflows, applications, and integrations
Ability to translate provider-domain/business requirements into technical specifications and solutions
Experience collaborating with provider operations, business SMEs, architects, developers, integration teams, and other technical stakeholders