PwC Health Industries - Payer Service Ops – Manager in New York, New York
Industry/Sector: Health Services
Time Type: Full time
Travel Requirements: Up to 80%
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 Manager, 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:
Develop new skills outside of comfort zone.
Act to resolve issues which prevent the team working effectively.
Coach others, recognise their strengths, and encourage them to take ownership of their personal development.
Analyse complex ideas or proposals and build a range of meaningful recommendations.
Use multiple sources of information including broader stakeholder views to develop solutions and recommendations.
Address sub-standard work or work that does not meet firm's/client's expectations.
Use data and insights to inform conclusions and support decision-making.
Develop a point of view on key global trends, and how they impact clients.
Manage a variety of viewpoints to build consensus and create positive outcomes for all parties.
Simplify complex messages, highlighting and summarising key points.
Uphold the firm's code of ethics and business conduct.
Additional Job Description
Minimum Degree Required: Bachelor Degree
Minimum Years of Experience: 5 year(s)
Preferred Qualifications: Degree Preferred, Masters Degree
Demonstrates intimate knowledge of, and/or success 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.
Demonstrates intimate knowledge of, and proven success in:
Payer operations strategy – Sales, Marketing, Benefits/Products, Clinical Management, and Core Operations (Enrollment, Claims, Billing, and Customer Service)
Domain expertise – Data & Analytics, Automation, Artificial Intelligence, Health Advocacy, Medical Trend Analysis, and Cost Benchmarking.
Government Programs Experience with Medicare Advantage and Medicaid program requirements such as:
Program implementation, product/market expansion and Growth
Program compliance, risk and regulatory compliance
Experience with Risk Adjustment programs and methodologies, 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-leading practices in order to develop insights and provide recommendations.
Demonstrates a high level 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
Leveraging quantitative analyses to construct analytical frameworks and synthesize complex data into meaningful insights.
For positions in Colorado, visit the following link for information related to Colorado's Equal Pay for Equal Work Act: https://pwc.to/coloradoadvisorymanager .
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.
PwC 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
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.
Please note that, at this time, to be in-person at a PwC office, client location or PwC-sponsored events, you must be fully vaccinated against COVID-19.