Line of Service

Advisory

Industry/Sector

Technology

Specialism

Managed Services

Management Level

Senior Associate

Job Description & Summary

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.

In operations and solutions at PwC, you will focus on providing consulting services to optimise overall operational performance and develop innovative solutions. You will work closely with clients to analyse operational processes, identify areas for improvement, and develop strategies to enhance productivity, quality, and efficiency. Working in this area, you will provide guidance on implementing technology solutions, process automation, and operational excellence frameworks.

Focused on relationships, you are building meaningful client connections, and learning how to manage and inspire others. Navigating increasingly complex situations, you are growing your personal brand, deepening technical expertise and awareness of your strengths. You are expected to anticipate the needs of your teams and clients, and to deliver quality. Embracing increased ambiguity, you are comfortable when the path forward isn’t clear, you ask questions, and you use these moments as opportunities to grow.

Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to:

Respond effectively to the diverse perspectives, needs, and feelings of others.Use a broad range of tools, methodologies and techniques to generate new ideas and solve problems.Use critical thinking to break down complex concepts.Understand the broader objectives of your project or role and how your work fits into the overall strategy.Develop a deeper understanding of the business context and how it is changing.Use reflection to develop self awareness, enhance strengths and address development areas.Interpret data to inform insights and recommendations.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.

Job Summary - 

A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Appeals and Grievances Managed Services (AGMS) team will provide you with the opportunity to act as an extension of our healthcare clients' business office. We specialize in appeal and grievances functions and addressing member complaints for health plans and their business partners. We leverage our clients’ customized workflows and associated automations in conjunction with PwC’s data advanced data analysis and quality assurance processes to enable our clients to achieve better compliant results, which ultimately allows them to provide better services to their members.

Minimum Degree Required (BQ) *:

 Bachelor's degree

Degree Preferred:  

Bachelor's degree

Required Field(s) of Study (BQ):  

Any Graduate

Preferred Field(s) of Study:

 Any Graduate

Minimum Year(s) of Experience (BQ) *: US

 5+ years of experience (Payor side of business)

Certification(s) Preferred:

AHM 250 (Added advantage)

Preferred Knowledge/Skills *:

5+ years overall experience and out of that minimum 2+ year  of experience in people management in US Healthcare ExperienceMedicare & Medicaid Appeals & GrievancesPeople Handling, Team ManagementDelivering SLAsInventory ManagementAttrition ManagementEngaging teamAct as a bridge between team and LeadershipResource UtilizationAttention to DetailReading and working on reportsDriving InnovationTeam BuildingHospital & Physicians BillingHIPAA

Shift timings: Flexible to work in night shifts (US Time zone)

Team Management and Leadership:

Team Lead or supervisor: Responsible for overseeing all activities within a team.Strategist: Responsible for deciding how to approach tasks and develop a plan to accomplish them.Communicator: Responsible for distributing information to team members and stakeholders.Organizer: Responsible for tracking and structuring various tasks, employees, and documents.Goal setter: Responsible for determining the goals that members will work toward.

Insurance and Payer Relations:

Handle escalated insurance claim issues and complex payer inquiries, providing expertise and assistance to team members. Develop and maintain relationships with insurance company representatives to expedite claim processing and resolve payment delays. Stay informed about changes in insurance policies, billing guidelines, and reimbursement regulations.

Process Improvement and Training:

Identify opportunities for process enhancements and workflow optimization within the A&G function. Develop and deliver training programs to equip team members with the skills and knowledge necessary to excel in their roles. Implement best practices and standard operating procedures to drive operational efficiency and quality outcomes.

Reporting and Analysis:

Generate regular reports on team performance metrics, KPIs, and key trends. Analyze data to identify areas of improvement, implement corrective actions, and track progress towards goals.

Education (if blank, degree and/or field of study not specified)

Degrees/Field of Study required:

Degrees/Field of Study preferred:

Certifications (if blank, certifications not specified)

Required Skills

Optional Skills

Accepting Feedback, Accepting Feedback, Active Listening, Analytical Thinking, Automation Solutions, Business Process Improvement, Communication, Competitive Advantage, Cost Efficiency, Creativity, Demand Management, Embracing Change, Emerging Technologies, Emotional Regulation, Empathy, Inclusion, Intellectual Curiosity, Lean Process Improvement, Learning Agility, Operating Model, Operational Analysis, Operational Excellence, Operational Support and Analysis, Operations Management, Operations Process Improvement {+ 14 more}

Desired Languages (If blank, desired languages not specified)

Travel Requirements

Not Specified

Available for Work Visa Sponsorship?

No

Government Clearance Required?

No

Job Posting End Date