Healthcare Payer Strategist

Overview

At Commence, we’re the start of a new age of data‑centric transformation, elevating health outcomes and powering better, more efficient processes for program and patient health. We combine quality data‑driven solutions, advancing performance technology and clinical expertise to create a more efficient path to quality care.

With human‑centered, healthcare‑relevant, value‑based solutions, we create new possibilities with data, proving performance beyond scope with a focus on efficiencies that transform lives. A culture driven by purpose, straightforward communication and clinical domain expertise lets Commence cut straight to better care.

The Healthcare Payer Strategist partners closely with sales, customer success, product and engineering to translate complex payer workflows, data and compliance needs into practical solutions. The SME provides 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.

• 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 reflect payer needs, compliance requirements and workflow realities in product design and roadmap decisions.
• Provide guidance during customer implementations to align solutions with payer business processes and regulatory standards.
• Function as a trusted advisor to customers to optimize platform use for 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 impacting payers.
• Support customer success and support teams in resolving complex payer‑related issues and escalations.
• Identify 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 Credibility.
• Train and enable internal teams (Sales, CSMs, Support) on payer concepts, workflows, and compliance considerations.
• Other duties as requested or assigned by supervisor.

• 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. Unless you are requesting an accommodation, all applications must be submitted through our online application system.