Healthcare Payer Strategist at Commence – Virginia Beach, Virginia

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

The Healthcare Payer Strategist will play a significant role in the growth and success of Commence in the Commercial Healthcare markets. The ideal candidate serves as a trusted authority on payer operations, policy and regulatory requirements and will support both internal teams and external customers. This role partners closely with sales, customer success, product and engineering to translate complex payer workflows, data and compliance needs into practical solutions. The SME will provide strategic guidance throughout the sales cycle and post-implementation to ensure our technology aligns with real payer challenges while helping healthcare organizations improve outcomes, efficiency and program integrity.

Essential Duties and Responsibilities

· Serve as the primary expert on healthcare payer operations, including Medicaid, Medicare, and commercial insurance workflows, policies, and regulations.

· Support sales and pre-sales activities by providing specific expertise during discovery, solution design and customer presentations.

· Translate complex payer requirements into clear product use cases, configuration guidance and solution recommendations.

· Partner with product management and engineering to ensure payer needs, compliance requirements and workflow realities are reflected in product design and roadmap decisions.

· Provide guidance during customer implementations to ensure solutions align with payer business processes and regulatory standards.

· Function as a trusted advisor to customers to help them optimize their use of the platform to achieve program, compliance and financial outcomes.

· Develop and maintain payer focused documentation, best practices and enablement materials for internal teams and clients.

· Stay current on healthcare policy, reimbursement models, fraud, waste and abuse (FWA) programs and regulatory changes that impact payers.

· Support customer success and support teams in resolving complex payer related issues and escalations.

· Assist in identifying new product opportunities based on emerging payer needs, data trends and regulatory shifts.

· Participate in industry forums, conferences and customer meetings to represent payer expertise and strengthen the company’s credibility.

· Help train and enable internal teams (Sales, CSMs, Support) on payer concepts, workflows, and compliance considerations.

· Other duties as requested or assigned by supervisor.

Qualifications

· Bachelor’s degree in healthcare administration, public health or another related field.

· Minimum of 7+ years of experience working within healthcare payer organizations (Medicaid, Medicare or commercial insurance) or in a payer focused consulting or technology role.

· Deep knowledge of payer operations, including claims processing, eligibility, provider networks, utilization management and payment integrity.

· Strong understanding of healthcare regulations and compliance frameworks, including CMS guidelines, HIPAA and state Medicaid requirements.

· Experience working directly with product, engineering or data teams to define requirements and validate solutions.

· Strong written and verbal communication skills with the ability to engage with senior-level stakeholders as needed.

· Proven ability to serve as a trusted advisor to customers, executives and internal stakeholders.

· Demonstrated ability to work solo as well as being a productive team member.

· Must be able to travel within the United States on a quarterly basis while maintaining professionalism.

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.