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PwC HIA Payer Ops - Health Value Management- Experienced Associate in New York, New York

Specialty/Competency: Operations

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 an 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:

  • Invite and give in the moment feedback in a constructive manner.

  • Share and collaborate effectively with others.

  • Identify and make suggestions for improvements when problems and/or opportunities arise.

  • Handle, manipulate and analyse data and information responsibly.

  • Follow risk management and compliance procedures.

  • Keep up-to-date with developments in area of specialism.

  • Communicate confidently in a clear, concise and articulate manner – verbally and in the materials I produce.

  • Build and maintain an internal and external network.

  • Seek opportunities to learn about how PwC works as a global network of firms.

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

Basic Qualifications :

Minimum Degree Required :

Bachelor Degree

Additional 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 :

1 year(s)

Preferred Qualifications :

Preferred Fields of Study :

Actuarial Science, Business Administration/Management, Finance, Nursing, Health Administration

Additional Educational Preferences :

Master of Health Care Admin/Master of Public Health

Preferred Knowledge/Skills :

Demonstrates some abilities and/or a proven record of success as a team member supporting efforts in working in large teams through the design and implementation of changes to Middle Office Operations, including people, process and technology and the following:

  • Having prior consulting or project-based experience;

  • Identifying, addressing and managing client needs;

  • Managing project workflows, budgets, billing and collections;

  • Preparing and/or coordinating complex written and verbal materials;

  • Creating an atmosphere of trust and seeking diverse views to encourage improvement and innovation;

  • Answering questions and providing direction to less experienced staff;

  • Working experience in Payer Middle Office operations (domain areas such as Medical Management, Population Health Management, Utilization Management, Provider Network Management, Value-Based Contracting, Provider Relations, Quality Improvement, Program/Payment Integrity, Risk Adjustment and Pharmacy Benefit Management) to help payers manage their medical costs;

  • Working experience in Actuarial, Medical Economics, Claims groupings (e.g., ETG), and Population Health Analytics or working in collaboration with related functions;

  • Working experience with Population Health Management technologies (e.g., high-risk user stratification tools, cost/quality/utilization trend analysis, provider performance tools);

  • Working experience with Provider Network contracting domains including: value-based / risk contracting; specialty and behavioral health contracting; provider performance incentive management; alternative model contracting strategies, such as with community-based organizations and social needs providers; and,

  • Understanding of global trends for health organizations utilizing pragmatic approaches to achieve sustainable financial functions and operating models.

For positions in Colorado, visit the following link for information related to Colorado's Equal Pay for Equal Work Act: .

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:

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.