Healthcare Subject Matter Expert (SME)

About Apexon:

Apexon is a digital-first technology services firm specializing in accelerating business transformation and delivering human-centric digital experiences. We have been meeting customers wherever they are in the digital lifecycle and helping them outperform their competition through speed and innovation.Apexon brings together distinct core competencies – in AI, analytics, app development, cloud, commerce, CX, data, DevOps, IoT, mobile, quality engineering and UX, and our deep expertise in BFSI, healthcare, and life sciences – to help businesses capitalize on the unlimited opportunities digital offers. Our reputation is built on a comprehensive suite of engineering services, a dedication to solving clients’ toughest technology problems, and a commitment to continuous improvement. Backed by Goldman Sachs Asset Management and Everstone Capital, Apexon now has a global presence of 15 offices (and 10 delivery centers) across four continents. 

We enable #HumanFirstDIGITAL

Healthcare Subject Matter Expert (SME)

Experience: 8+ Years

Job Summary:

We are seeking an experienced Healthcare Subject Matter Expert (SME) with 8+ years of industry experience to provide domain expertise, strategic guidance, and functional leadership across healthcare projects and digital transformation initiatives.

The ideal candidate should possess strong knowledge of healthcare operations, payer/provider workflows, regulatory compliance, and healthcare IT systems. The SME will act as the bridge between business stakeholders, clinical teams, and technical teams to ensure solutions align with industry standards and business objectives.

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Key Responsibilities:

• Serve as the primary healthcare domain expert for projects and client engagements.
• Gather and analyse business requirements related to healthcare operations (payer, provider, pharmacy, population health).
• Translate healthcare business needs into functional and technical requirements.
• Provide expertise in:

Claims processing and adjudication

Member enrolment and eligibility

Provider lifecycle management

Revenue Cycle Management (RCM)

Care management & utilization management

• Ensure compliance with healthcare regulations and standards.
• Support implementation of healthcare IT systems such as:

Epic Systems

Cerner

Meditech

• Guide integration with interoperability standards such as:

HL7

FHIR

• Ensure adherence to regulatory frameworks such as:

HIPAA

HITECH Act

• Work closely with data and analytics teams to define healthcare KPIs and reporting standards.
• Conduct impact analysis, UAT validation, and stakeholder training.
• Provide strategic input on healthcare digital transformation initiatives.

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Required Skills & Qualifications:

• 8+ years of experience in healthcare domain (payer/provider).
• Strong knowledge of healthcare business processes and workflows.
• Experience working with EHR/EMR systems.
• Deep understanding of healthcare compliance, regulatory requirements, and data privacy.
• Familiarity with ICD, CPT, HCPCS coding standards.
• Experience in healthcare analytics, reporting, and data interpretation.
• Strong documentation skills (BRD, FRD, Process flows).
• Experience working in Agile and Waterfall methodologies.

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Preferred Qualifications:

• Experience in healthcare product implementation or consulting.
• Knowledge of value-based care models and population health management.
• Exposure to healthcare cloud platforms.
• Six Sigma / Lean certification (good to have).
• Healthcare-related certifications.
• Bachelor's degree or master's degree is required

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Soft Skills:

• Excellent stakeholder management skills
• Strong communication and presentation skills
• Problem-solving and analytical mindset
• Leadership and mentoring capabilities
• Ability to work with cross-functional global teams

Our Commitment to Diversity & Inclusion:

Did you know that Apexon has been Certified™ by Great Place To Work®, the global authority on workplace culture, in each of the four regions in which it operates: USA (for the seventh time in 2026), India (for the tenth consecutive time in 2026), the UK(for the fourth time in 2026) and Mexico (for the second time in 2026). Apexon is committed to being an equal opportunity employer and promoting diversity in the workplace. We take affirmative action to ensure equal employment opportunity for all qualified individuals. Apexon strictly prohibits discrimination and harassment of any kind and provides equal employment opportunities to employees and applicants without regard to gender, race, color, ethnicity or national origin, age, disability, religion, sexual orientation, gender identity or expression, veteran status, or any other applicable characteristics protected by law. You can read about our Job Applicant Privacy policy here Job Applicant Privacy Policy (apexon.com)

Our Commitment to Environment:

Actively contribute to Apexon's commitment to environmental responsibility by following sustainable practices and supporting ESG initiatives.

Our Perks and Benefits:

Our benefits and rewards program has been thoughtfully designed to recognize your skills and contributions, elevate your learning/upskilling experience and provide care and support for you and your loved ones. As an Apexon Associate, you get continuous skill-based development, opportunities for career advancement, and access to comprehensive health and well-being benefits and assistance.

We also offer:

oHealth Insurance with Dental & Vision

o401K Plan

oLife Insurance, STD & LTD

oPaid Vacations & Holidays

oPaid Parental Leave

oFSA Dependent & Limited Purpose care

Job Location :

Plano, United States