Usage of Conventional AI
Virtusa utilizes Artificial Intelligence (AI) technology for the purpose of conducting candidate pre-employment assessments. This AI may include both text-based and voice-based functionalities. The AI technology will have access to the data that you upload or provide during your interaction with the AI bot and will use such data solely for the purpose of performing assessment in accordance with Virtusa policies and practices. The AI is not used to substantially assist or replace discretionary employment decisions. Read our full employee privacy policy here.
Principal Domain Consultant – Healthcare Contact Center & Appeals & Grievances (A&G)
Job description
Qualification
Key Responsibilities
1. Contact Center Assessments (Payer Focused)
- Lead end-to-end contact center maturity assessments across:
- Member Services, Provider Services, Pharmacy Services, and Enrollment
- Evaluate:
- Call routing, IVR, omnichannel strategy
- Average Handle Time (AHT), First Call Resolution (FCR), abandonment, ASA
- Workforce management, QA, training, and escalation models
- Identify root causes of member abrasion, repeat calls, and avoidable contacts
- Benchmark against CMS, NCQA, and industry best practices
- Develop future-state operating models, including automation and digital deflection opportunities
2. Appeals & Grievances (A&G) Assessments
- Conduct comprehensive A&G operational and compliance assessments across:
- Intake, classification, investigation, determination, and notification
- Evaluate compliance with:
- CMS regulations (MA, Medicaid, ACA)
- Timeliness standards, notice language, and audit readiness
- Identify gaps in:
- End-to-end workflows
- Case routing, medical necessity reviews, and decision governance
- Vendor oversight and delegation models
- Assess linkages between contact center complaints → grievances → appeals
- Deliver regulator-ready remediation and improvement roadmaps
3. Executive Advisory & Stakeholder Leadership
- Serve as primary domain authority for client leadership (VP–C-suite)
- Facilitate executive workshops, readouts, and decision forums
- Translate regulatory requirements into clear operational actions
- Influence cross-functional leaders (Operations, Compliance, Medical, IT)
4. Transformation Strategy & Roadmap Development
- Define multi-year transformation roadmaps spanning:
- Process simplification
- Technology enablement (CRM, case management, workflow)
- Automation and AI (intelligent routing, summarization, QA augmentation)
- Partner with solution architects and delivery teams to ensure feasible execution
- Support business case development (ROI, cost take-out, experience uplift)
Experience
- 14–18+ years in healthcare payer operations, consulting, or advisory roles
- Deep hands-on experience in:
- Healthcare contact center operations and/or
- Appeals & Grievances (A&G) for MA, Medicaid, or Commercial plans
- Prior experience in:
- Top-tier or boutique healthcare consulting firms OR
- Senior leadership roles within a health plan
Domain Expertise
- Strong command of:
- CMS regulations (MA & Medicaid)
- A&G timeliness, notice, and audit requirements
- Member and provider experience drivers
- Working knowledge of:
- CRM and case management platforms – Pega Blueprint, Pega workflow
- Call center technologies (IVR, WFM, QA, omnichannel tools)
- Familiarity with NCQA, STAR Ratings, and state DOI oversight
Key job details
About Virtusa
Teamwork, quality of life, professional and personal development: values that Virtusa is proud to embody. When you join us, you join a team of 30,000 people globally that cares about your growth — one that seeks to provide you with exciting projects, opportunities and work with state of the art technologies throughout your career with us.
Great minds, great potential: it all comes together at Virtusa. We value collaboration and the team environment of our company, and seek to provide great minds with a dynamic place to nurture new ideas and foster excellence.
Virtusa is an Equal Opportunity Employer. All applicants will receive fair and impartial treatment without regard to race, color, religion, sex, national origin, ancestry, age, legally protected physical or mental disability, protected veteran status, status in the U.S. uniformed services, sexual orientation, gender identity or expression, marital status, genetic information or on any other basis which is protected under applicable federal, state or local law.
Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government-issued ID during each interview. All candidates must be authorized to work in the USA.
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