Payer Operations - Manager

Specialty/Competency: OperationsIndustry/Sector: Health ServicesTime Type: Full timeTravel Requirements: Up to 60%At PwC, our people in operations consulting specialise in providing consulting services on optimising operational efficiency and effectiveness. These individuals analyse client needs, develop operational strategies, and offer guidance and support to help clients streamline processes, improve productivity, and drive business performance.As an operations consulting generalist at PwC, you will possess a broad understanding of various aspects of operations consulting. You will provide comprehensive guidance and support to clients in optimising operational efficiency and effectiveness. Working in this area, you will analyse client needs, develop operational solutions, and offer recommendations tailored to specific business requirements.Enhancing your leadership style, you motivate, develop and inspire others to deliver quality. You are responsible for coaching, leveraging team member’s unique strengths, and managing performance to deliver on client expectations. With your growing knowledge of how business works, you play an important role in identifying opportunities that contribute to the success of our Firm. You are expected to lead with integrity and authenticity, articulating our purpose and values in a meaningful way. You embrace technology and innovation to enhance your delivery and encourage others to do the same.Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to:

Analyse and identify the linkages and interactions between the component parts of an entire system.

Take ownership of projects, ensuring their successful planning, budgeting, execution, and completion.

Partner with team leadership to ensure collective ownership of quality, timelines, and deliverables.

Develop skills outside your comfort zone, and encourage others to do the same.

Effectively mentor others.

Use the review of work as an opportunity to deepen the expertise of team members.

Address conflicts or issues, engaging in difficult conversations with clients, team members and other stakeholders, escalating where appropriate.

Uphold and reinforce professional and technical standards (e.g. refer to specific PwC tax and audit guidance), the Firm's code of conduct, and independence requirements.

Minimum Degree RequiredBachelor's DegreeMinimum Year(s) of Experience5 year(s)Degree PreferredMaster's DegreePreferred Knowledge/SkillsDemonstrates extensive abilities and/or a proven record of success as a team leader, and in operations roles within a professional services firm or corporate environment, helping companies to identify, clarify and resolve complex issues critical to their strategic and operating success, including:

Payer operations strategy - Sales, Marketing, Benefits/Products, Clinical Management, and Core Operations (Enrollment, Claims, Billing, and Customer Service); and,

Domain expertise - Data & Analytics, Automation, Artificial Intelligence, Health Advocacy, Cost Benchmarking and Complex Project/Program Management

Demonstrates extensive abilities and/or a proven record of success as a team leader with Payer Operations Experience relating to Transformation program requirements such as:

Program implementation, product/market expansion and Growth;

Experience with quality programs and provider network design;

Business Development - growing existing clients and developing new clients within the Payor sector;;

Payer industry market trends and industry as it relates to leading practices in order to develop insights and provide recommendations;

Experience across payer back office, specifically to drive growth across operations, IT and strategy engagements;

Domain experience across areas that include: claims, enrollment, billing, membership, provider data, product management, and related functions;

Experience with either process level familiarity and/or familiarity with the technology solutions that enable payer back-office functions;

Experience with payer back-office technology platforms such as COTS platforms including TriZetto Facets/QNXT, HealthEdge, and;

Experience with data and systems interactions including IT tools and technology.

​Demonstrates extensive abilities and/or a proven record of success of leadership, strategic and creative thinking, problem solving, individual initiative, and the following abilities:

Leading teams to generate a vision and creating an atmosphere of trust, leveraging diverse views and encouraging improvement and innovation;

Building productive and collaborative relationships with team members and proactively providing and seeking guidance, clarification and feedback;

Leading a team to a successful project conclusion through problem solving complex operations issues;

Managing the planning, organizing and delivery of operations tasks and projects, overseeing independent analyses and ensuring the quality of client deliverables;

Leading the development and improvement of various frameworks and methodologies within operations;

Identifying and addressing client needs: building, maintaining, and utilizing networks of client relationships;

Communicating effectively in an organized and knowledgeable manner in written and verbal formats; and,

Leveraging quantitative analyses to construct analytical frameworks and synthesize complex data into meaningful insights.

Learn more about how we work: https://pwc.to/how-we-workPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer.For positions based in San Francisco, consideration of qualified candidates with arrest and conviction records will be in a manner consistent with the San Francisco Fair Chance Ordinance.Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines: https://pwc.to/us-application-deadlinesThe salary range for this position is: $100,000 - $232,000, plus individuals may be eligible for an annual discretionary bonus. For roles that are based in Maryland, this is the listed salary range for this position. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glance#LI-Hybrid