InterSystems has been a leader in the digital health space since its inception. We work with healthcare payers, providers, regional health networks, MedTech, and health IT companies like Epic and Optum. Today, more than 1 billion health records worldwide are managed using InterSystems technology. That technology includes our HealthShare interoperability product suite, IntelliCare, our electronic medical record system deployed in 28 countries outside the US, and InterSystems IRIS for Health, the data platform created specifically for the development of healthcare solutions.
Our HealthShare Platform products provides advanced technology for strategic interoperability and analytics for action, bringing care delivery data to health plans at a tremendous scale. We enable Health Plans to meet regulatory requirements, improve care coordination and care management, make operational processes more efficient, enhance quality and streamline measurement, and optimize network performance.
The Role
This role serves as the company’s go-to authority on Public Sector healthcare program integrity (FWA), translating policy, data, and mission outcomes into scalable technology-led solutions. InterSystems’ mission is to help agencies reduce improper payments, improve program integrity, and increase trust in public healthcare systems. We believe we can do this by enabling measurable impact in fraud reduction, cost avoidance, and beneficiary outcomes.
This role resides in our broader “Subject Matter Expert” team. This team was formed as a result of our recognition that specific expertise and focus are required for our fastest growing business segments, which includes Public Sector. Our team of Subject Matter Experts continues to expand its capabilities and the opportunity for impact in this role is profound.
Reporting to the Director of North American Sales Engineering, the Public Sector Subject Matter Expert (PS-SME) is responsible for influencing and accelerating complex public sector deal cycles. The PS-SME will attain trusted advisor status both within InterSystems and within our public sector prospects and customers and will focus on policy-to-technology translation. In scope use cases might include claims analytics / anomaly detection, identity & eligibility verification, provider fraud detection, data matching / cross-agency analytics, AI/ML use in improper payment detection, etc.
The execution of this strategy in partnership with field sales teams in the United States will support sustained growth and enhance brand equity and awareness.
Responsibilities
- Work closely with business unit leadership to enhance our Public Sector go-to-market and sales strategies.
- Work closely with Field Sales to educate them on customer buying patterns and devise strategies to accelerate opportunity development to closure, based on their target accounts and overall go-to-market strategy.
- Provide input and leadership of creative sales campaigns, programs, and materials.
- Ensure effective and consistent usage of key themes and messaging.
- Drive creation of product and market-specific content to support strategic campaigns aligned to regulatory cycles and funding programs. These will align to core product management and marketing value propositions, support lead generation campaigns (for instance, identifying campaign themes) and identify and present customer success stories.
- Participate in PR, analyst, social media activities, and public speaking at various types of events.
- Analyze buyer behavior, procurement patterns, and policy drivers, as well as competitors’ offerings to identify and devise differentiation strategies for sales opportunities.
Qualifications
- Extensive prior work experience in healthcare and with healthcare technology.
- Deep subject matter expertise in healthcare policy with a focus on fraud, waste, and abuse (FWA) prevention, detection, program integrity, and cost containment initiatives.
- Cross-agency expertise at both the state and federal levels, including work with healthcare, SNAP, taxation and regulatory environments.
- Experience advising on statewide enterprise initiatives involving data interoperability, data sharing, data analysis and policy-driven program oversight.
- Strong knowledge of compliance frameworks, improper payment prevention and recovery, and government accountability requirements.
- Expertise in eligibility verification programs, identity validation, and benefits integrity operations.
- Recognized thought leadership in public sector program integrity, compliance modernization, and government technology transformation.
- Experience providing testimony or serving as a subject matter advisor in Congressional hearings, state legislative hearings, or formal government oversight proceedings.
- Proven ability to develop strategic sales plays, solution positioning, and executive-level messaging in support of software sales to state and federal government agencies.
- Ability to partner effectively with sales, capture, and solution teams to align technical and policy expertise with government procurement priorities and mission outcomes.
- Minimum 10 years of experience working in the Public Sector Healthcare domain, in multiple functional areas.
- 3 years of experience with technology or consulting organizations which support Public Sector Healthcare IT.
- Evidence of highly creative thinking translating into tangible and positive business outcomes.
- A demonstrable track record of leading successful sales initiatives.
- Solid writing skills and experience assisting with RFP/RFI responses.
- Experience and solid understanding of Public Sector Healthcare regulations and requirements.
- Excellent analytical skills and attention to detail.
- Positive, inquisitive attitude and a strong work ethic.
Success Criteria (First 12–18 Months)
- Establish InterSystems as a recognized thought leader in Public Sector healthcare program integrity (FWA).
- Influence and support qualified pipeline tied to Public Sector healthcare opportunities.
- Develop and deploy 2-3 repeatable “sales plays” aligned to:
- Medicaid program integrity
- CMS compliance/improper payment reduction
- Cross-agency data sharing initiatives
- Deliver impactful executive engagements with state Medicaid agencies, CMS, and oversight organizations.
- Contribute to winning strategic deals by shaping messaging, positioning, and differentiation.
- Build trusted relationships with key stakeholders (Medicaid Directors, Program Integrity leads, CIOs, SIU leaders).
- Produce high-value assets:
- Thought leadership content (whitepapers, presentations)
- Demo narratives aligned to FWA use cases
- Support successful RFP/RFI responses with domain expertise.
- Drive measurable differentiation vs. competitors (Optum, Gainwell, Conduent, etc.).
Education & Training
Bachelor's degree or equivalent experience required; advanced degree(s) preferred.
Preferred Certifications
- Certified Fraud Examiner (CFE)
- Certified Professional in Healthcare Quality (CPHQ)
- Certified Healthcare Financial Professional (CHFP)
- Project Management Professional (PMP) (for large state initiatives)
- Certified Analytics Professional (CAP) (nice-to-have for data-driven positioning)
- Relevant CMS / Medicaid Program Integrity training or certifications
- Cloud certifications (AWS, Azure, GCP) especially in data/analytics (optional but valuable)
Industry Knowledge & Expertise
- Deep understanding of:
- Medicaid & Medicare program structures
- CMS oversight and compliance requirements
- Improper Payment Measurement (IPM) programs (e.g., PERM)
- Knowledge of:
- Program Integrity operations (SIU, audits, investigations)
- Claims lifecycle and payment systems
- Familiarity with:
- Federal regulations (e.g., CFR, CMS mandates)
- State Medicaid waivers and funding mechanisms
- Experience with:
- Data interoperability standards (HL7, FHIR)
- Cross-agency data sharing (health + human services + taxation)
- Awareness of the vendor landscape:
- Optum
- Gainwell
- Conduent
- LexisNexis Risk
- SAS (FWA analytics)
- Understanding of:
- AI/ML applications in fraud detection
- Identity verification and digital trust frameworks
Knowledge of budgeting, procurement, and funding cycles in state/federal government
We are an equal-opportunity employer and do not discriminate because of race, color, religion, sex, national origin, ancestry, marital status, veteran status, age, disability, sexual orientation or gender identity or expression or any other legally protected category. InterSystems is an E-Verify Employer in the United States.
About InterSystems
InterSystems, a creative data technology provider, delivers a unified foundation for next-generation applications for healthcare, finance, manufacturing, and supply chain customers in more than 80 countries. Our data platforms solve interoperability, speed, and scalability problems for large organizations around the globe to unlock the power of data and allow people to perceive data in imaginative ways. Established in 1978, InterSystems is committed to excellence through its 24×7 support for customers and partners around the world. Privately held and headquartered in Boston, Massachusetts, InterSystems has 38 offices in 28 countries worldwide. For more information, please visit InterSystems.com.
AI Disclaimer
InterSystems may use AI tools for its internal operations including administrative tasks during recruitment (e.g., organizing candidate information). InterSystems’ approach to AI is guided by the InterSystems Responsible AI Guidelines. AI is not used to make or influence hiring decisions. All decisions are made by InterSystems employees.
Candidates may use AI for CV or interview preparation, provided materials are truthful and reflect their own experience. AI tools and third-party transcription services must not be used during interviews or assessments.
Please note that the use of wearable technology, including any AI-related tools or other technology-connected devices (such as META or Google smart glasses and/or wearables, and/or any similar devices), is strictly prohibited during the interview and screening process with InterSystems. Any applicant who requires a wearable device or any type of technology support during the interview process as a reasonable accommodation under the ADA or applicable state or country laws and regulations must contact the InterSystems Human Resources Department prior to attending or participating in any interview or screening process.