Payer Operations - Senior Associate

Specialty/Competency: OperationsIndustry/Sector: Health ServicesTime Type: Full timeTravel Requirements: Up to 60%A career within Operations Consulting services, will provide you with the opportunity to help our clients optimise all elements of their operations to move beyond the role of a cost effective business enabler and become a source of competitive advantages. We focus on product innovation and development, supply chain, procurement and sourcing, manufacturing operations, service operations and capital asset programmes to drive both growth and profitability.To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.As a Senior Associate, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to:

Use feedback and reflection to develop self awareness, personal strengths and address development areas.

Delegate to others to provide stretch opportunities, coaching them to deliver results.

Demonstrate critical thinking and the ability to bring order to unstructured problems.

Use a broad range of tools and techniques to extract insights from current industry or sector trends.

Review your work and that of others for quality, accuracy and relevance.

Know how and when to use tools available for a given situation and can explain the reasons for this choice.

Seek and embrace opportunities which give exposure to different situations, environments and perspectives.

Use straightforward communication, in a structured way, when influencing and connecting with others.

Able to read situations and modify behavior to build quality relationships.

Uphold the firm's code of ethics and business conduct.

Job Requirements and Preferences :Basic Qualifications :Minimum Degree Required :Bachelor DegreeAdditional Educational Requirements :In lieu of a Bachelor Degree, 12 years of professional experience involving technology-focused process improvements, transformations, and/or system implementations.Minimum Years of Experience :3 year(s)Preferred Qualifications :Degree Preferred :Masters DegreePreferred Knowledge/SkillsDemonstrates thorough 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 thorough 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 thorough 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: $84,000 - $202,000, 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