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Health Plan/PBM Expert

Date Posted: Jun 16, 2026

Job #1688308
Contract
Houston, Texas, USA
100.00 - 125.00 per hour (USD)

Interim Payer Strategy Advisor (Healthcare Data / Analytics)

Position Overview

An emerging healthcare data and analytics organization is seeking a fractional Payer Strategy Advisor to support expansion into the health plan market. This role will act as a strategic partner to executive leadership, providing guidance on how to position and commercialize a data-driven product offering to large payer organizations.

This individual will bring deep expertise in payer operations, including actuarial methodologies, risk modeling, and premium pricing, and will help shape the go-to-market strategy for a new target customer segment.


Key Responsibilities

  • Advise executive leadership on go-to-market strategy for entering the payer segment
  • Define and refine value propositions for payer organizations, including health plans and insurers
  • Identify target buyer personas (e.g., actuarial, network, medical economics, product teams) and engagement strategies
  • Provide insights into payer decision-making processes, including purchasing criteria and internal stakeholders
  • Translate product capabilities into payer-relevant business outcomes, including cost savings, risk optimization, and care management improvements
  • Support development of business cases, pricing models, and commercialization strategies
  • Provide guidance on product-market fit, including feature enhancements and positioning
  • Collaborate with business development, product, and leadership teams to align strategy and execution

Required Qualifications

  • Significant experience working within or closely with large payer organizations (health plans/insurers)
  • Deep expertise in actuarial modeling, risk adjustment, premium pricing, or medical economics
  • Strong understanding of payer operations, including network strategy and financial performance drivers
  • Knowledge of Medicare Fee-for-Service and/or Medicare Advantage, including claims data and utilization patterns
  • Proven ability to develop and advise on go-to-market strategies and new product launches
  • Strong executive presence with the ability to influence C-suite stakeholders

Preferred Qualifications

  • Experience with healthcare data, analytics, or insights-driven products
  • Familiarity with life sciences and pharmaceutical ecosystems
  • Prior experience in consulting, advisory, or fractional leadership roles
  • Exposure to product strategy or commercialization in healthcare technology

Engagement Details

  • Type: Fractional / Advisory (approximately 10 hours per week)
  • Location: Remote
  • Duration: ~6 months (with potential extension)

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