Senior Clinical Specialist

The PositionSummaryThe position plays a critical role in driving the execution, development, and optimization of clinical coding and encoded data solutions across global and APAC markets. This role combines hands-on expertise in clinical coding, data standardization, and automation with emerging capabilities such as GenAI prompt development and billing schema design.The role is responsible for supporting end-to-end annotation, validation, research, and coding framework development, while ensuring high data quality, clinical relevance, and scalability. Acting as a key bridge between strategy and execution, the role collaborates closely with product, data science, and clinical teams to enhance AI-driven solutions, improve coding accuracy, and enable robust data-driven healthcare products.Also, the role contributes to stakeholder coordination, team capability building, and continuous innovation through research, data assessments, and implementation of best practices, ensuring alignment with organizational and Clinical Informatics objectives.Responsibilities1. Coding Portfolio Execution & DevelopmentSupport end-to-end clinical annotation, validation, and coding asset development activities across the portfolio.Drive improvements in encoded data coverage, accuracy, usability, and scalability aligned with global and regional implementations.Contribute to the design and development of coding frameworks, including: - Foundation and expansion of AH Billing Code across Clinical Domains- Assist with Crosswalks / mappings having downstream impact on AH productsDevelop and refine GenAI prompts and training datasets to enhance clinical coding automation and model accuracy.Collaborate with coding, interface, and data science teams to implement enhancements supporting automation and scalable workflows.Track performance metrics and identify opportunities to optimize encoded data and coding outputs.2. Stakeholder CoordinationEngage regularly with internal stakeholders (product, data science, analysts, coders) to align delivery priorities and coding requirements.Support external stakeholder engagements (clients, providers, regulators) to ensure coding standards and expectations are met.Facilitate working sessions, requirement discussions, and feedback loops to ensure alignment and continuous improvement.Act as a key contact for coding-related clarifications and cross-team coordination.3. Product & AI Enablement SupportPartner with product and data science teams to: - Improve product features through enhanced coding logic- Support GenAI model development using structured coding inputs and prompt engineeringProvide ongoing support for coding-related initiatives (e.g., Rules & Benefits, Asset Management).Contribute to solution design, requirement gathering, and feature validation for healthcare products.4. Coding Research & InnovationStay updated on international and APAC coding standards, classifications, billing practices, and regulatory changes.Conduct in-depth coding research and benchmarking across global healthcare systems (US, Canada, Australia, etc.).Extract and apply methodologies from leading healthcare organizations to strengthen internal coding practices.Collaborate with actuarial, data science, and clinical teams to ensure solutions are evidence-based and business-aligned.5. Annotation, Validation & Quality AssuranceOversee and contribute to annotation and validation across terminologies (ICD, CPT, SNOMED CT, LOINC, ATC, etc.).Ensure encoded data is clinically accurate, contextually relevant, and aligned with workflows and downstream use cases.Perform audits, quality checks, and variance analysis to ensure data integrity.Investigate discrepancies and propose resolution strategies for escalations.Review peer outputs, challenge assumptions, and provide structured feedback for continuous improvement.Support integration of validated data into Ground Truth datasets for analytics and AI modelling.6. Clinical Data Assessment & StandardizationSupport and execute market-specific data assessments, including: - Data profiling and gap analysis- Feasibility and readiness for coding standardizationContribute to schema design and data model validation, including: - Clinical and billing schema- Property structures and metadata frameworksEnsure alignment of data structures with clinical workflows, regulatory standards, and business use cases.7. Team Support, Operations & Capability BuildingContribute to creation and maintenance of SOPs, coding principles, and validation guidelines.Support sprint planning, backlog grooming, and execution tracking.Ensure all documentation is updated and aligned with regulatory and operational standards.Provide training and mentorship including: - Coding validation approaches- Market-specific requirements- Use of automation and AI tools in codingSupport capability building of team members and mentor junior coders.Facilitate knowledge sharing across regional and global teams.8. Cross-Portfolio SME SupportAct as a Subject Matter Expert (SME) across clinical portfolios.Provide expert input on: - Coding frameworks- Data standardization- AI/GenAI use cases in codingReview outputs, provide actionable feedback, and ensure alignment with Clinical Informatics strategy.Candidate ProfileExperience and QualificationsThe following requirements are essential: Graduate Health Care qualification required, preferred academic background: MBBS, BDS, BHMS, BAMS, Physiotherapy, Pharmacy or any other medical field.Master’s degree in Health Informatics, Clinical Sciences, Public Health, or Health Administration would be preferred.    5+ years of experience in health insurance, clinical coding, or claims analytics within Asia, or more globally, would be an advantage Deep knowledge of clinical coding assets, clinical terminologies, healthcare billing practices, and regulatory frameworks. Strong stakeholder management and communication skills across clinical, operational, and regulatory domains. Competencies & Core Characteristics:Technical understanding A working understanding of the data used in healthcare is optimal as data forms the basis of our products, as such the following core understandings are required: Understanding of healthcare specific data Reasonable competence in use of Microsoft Office suite of tools especially Excel, Access and PowerPoint. Knowledge of patient health management, provider profiling, healthcare reporting, and other key healthcare technologies, etc. Detailed knowledge and working experience of clinical tools and international coding including groupers, crosswalks and classification systems The following understandings are advantageous however not essential: SQL, python, and advanced excel Understanding of advanced statistics, risk adjustment and health outcome indices and metrics Knowledge of usage of data science in the healthcare space Experience in Microsoft Azure (Databricks, Synapse, Data Factory, etc.) Behavioral skills Demonstrated ability to effectively lead and actively manage teams of experienced clinical, multidisciplinary experts in their fields Exceptional communication skills across a wide range of stakeholders Ability to work cohesively in a team environment while balancing multiple priorities High level of attention to detail, resilience, enthusiasm, energy and drive Positive, can-do attitude focused on continuous improvement Ability to take feedback and constructive criticism to drive improved delivery Rigorous ability to solve problems and optimize environment Excellent co-ordination skills