[Hiring] Payer Workflow & Integration Lead @MCG Health

Role Description

The Payer Workflow & Integration Lead serves as a subject matter expert in payer-side healthcare workflows, system integrations, and data flows, supporting customer implementations through advisory guidance rather than execution. This role partners closely with Implementation, Product, and technical teams to identify risks early, answer complex workflow and integration questions, and guide solution design within real-world payer environments.

By bringing deep expertise in health plan operations and system interactions, this individual helps teams anticipate challenges, reduce implementation delays, and improve overall delivery quality. This role is critical in strengthening internal capability, reducing reliance on limited subject matter experts, and increasing customer confidence in how solutions function within their organizations.

You Will:

• Serve as a subject matter expert on payer workflows, system integrations, and data flows
• Advise implementation teams and customers on how solutions will function within complex payer environments
• Lead or support workflow discovery and provide guidance on integration design during customer implementations
• Identify risks, gaps, and potential blockers early in the implementation lifecycle and recommend solutions
• Act as an escalation point for complex workflow and integration-related questions and challenges
• Translate complex technical and operational concepts into clear, actionable guidance for internal teams and customers
• Partner cross-functionally with Product, Implementation, and technical teams to align on solution design and execution
• Support customer-facing discussions related to workflow, integrations, and how solutions operate within their environments
• Reduce dependency on Product teams by providing real-time workflow and integration expertise during implementations
• Analyze patterns across implementations to identify recurring issues and recommend systemic improvements
• Proactively assess customer environments to identify potential workflow and integration challenges prior to and during implementation
• Provide guidance on how payer-specific processes (e.g., utilization management, prior authorization) may impact solution design and configuration
• Facilitate working sessions with internal teams and customers to clarify workflows, integration points, and data dependencies
• Advise on trade-offs and alternative approaches when standard implementation paths do not align with customer environments
• Develop and maintain reusable artifacts (e.g., workflow diagrams, integration patterns, decision frameworks) to support consistent implementation outcomes
• Contribute to standardizing implementation approaches, best practices, and processes to improve efficiency and scalability
• Develop training materials and support cross-team enablement to expand workflow and integration knowledge
• Mentor and upskill implementation team members on payer workflows, integration concepts, and issue identification
• Provide field-driven feedback to Product teams on workflow gaps, integration challenges, and opportunities for enhancement
• Support pre-implementation or late-stage sales conversations as a subject matter expert to validate feasibility and set expectations
• Evaluate and recommend improvements to implementation processes to reduce cycle time and increase predictability
• Support resolution of complex integration and workflow-related challenges across customer engagements

Qualifications

• Bachelor’s degree in Healthcare Administration, Information Systems, Computer Science, Business, or a related field, or equivalent combination of education and experience
• At least 5 years of experience working with health plan (payer) systems, workflows, and operations
• Hands-on experience supporting or advising on healthcare implementations, system integrations, or workflow design within payer environments
• Strong understanding of end-to-end healthcare workflows, particularly within payer settings
• Demonstrated experience with system integrations and data flows across multiple platforms (e.g., APIs, HL7/FHIR, or similar standards)
• Proven ability to analyze, interpret, and translate business and technical requirements into actionable guidance
• Experience working cross-functionally with technical, operational, and business stakeholders
• Ability to diagnose complex workflow and integration issues and recommend effective solutions
• Strong communication skills, with the ability to engage effectively with both technical and non-technical audiences

Preferred Qualifications

• Knowledge of HL7 Da Vinci implementation guides, particularly related to Prior Authorization
• Knowledge of Utilization Management and/or Prior Authorization processes
• Strong written and verbal communication skills
• Strong problem-solving skills and ability to think beyond standard solutions
• Ability to collaborate across teams and influence without direct authority

Benefits

• Remote work
• Travel expected 3-4 times per year for company-sponsored events
• Medical, dental, vision, life, and disability insurance
• 401K retirement plan; flexible spending and health savings account
• 15 days of paid time off + additional front-loaded personal days
• 14 company-recognized holidays + paid volunteer days
• Up to 8 weeks of paid parental leave + 10 weeks of paid bonding leave
• LGBTQ+ Health Services
• Pet insurance
• Check out more of our benefits here