Health Payer Operations Manager/Consultant

$63,800 - $293,800/Yr

Accenture - Columbus, OH

Full-time - Mid Level

Columbus, OH

10,001+ employees

Professional, Scientific, and Technical Services

About the position

The Health Payer Operations Manager/Consultant at Accenture is responsible for leading initiatives to enhance claims processing efficiency and accuracy, manage provider network operations, and drive strategic improvements across health payer operations. This role involves analyzing workflows, ensuring compliance with regulations, and collaborating with various internal teams to achieve operational excellence and improve member satisfaction.

Responsibilities

• Lead initiatives to improve claims processing efficiency and accuracy, reducing operational costs and improving member satisfaction.
• Analyze claims workflows and identify bottlenecks or opportunities for automation to streamline processes.
• Ensure compliance with all regulatory requirements and payer policies across claims operations.
• Manage projects aimed at optimizing provider network operations, including provider onboarding, credentialing, contracting, and directory accuracy.
• Collaborate with network teams to improve provider experience and ensure network adequacy and accessibility standards are met.
• Evaluate provider relations and contracting processes to support payer-provider alignment and value-based care initiatives.
• Develop, implement, and monitor process improvement initiatives across claims and provider operations.
• Utilize data analytics and operational metrics to identify trends, monitor performance, and recommend adjustments as needed.
• Lead training and support change management efforts for new initiatives to ensure smooth transitions and process adoption.
• Partner with internal teams (e.g., IT, compliance, customer service) to ensure project goals align with organizational priorities.
• Communicate effectively with senior leadership, providing regular updates and progress reports.
• Serve as a subject matter expert and provide guidance to junior consultants or team members.
• Maintain current knowledge of state and federal health payer regulations and ensure compliance across all operational activities.
• Identify and mitigate operational risks within claims and network operations.
• Lead large-scale transformation initiatives in health payer operations, focusing on streamlining processes, enhancing service delivery, and achieving operational excellence.

Requirements

• Bachelor's degree in Healthcare Administration, Business, or related field.
• Minimum of 3 years of experience in healthcare consulting or enterprise operations improvement, with a focus with payer and/or provider clients.
• Minimum of 3 years of experience in health payer operations, particularly in claims and/or provider network operations.

Nice-to-haves

• Master's degree preferred.
• Strong knowledge of health insurance regulatory requirements, payer policies, and claims adjudication.
• Proven experience leading and executing process improvement projects in a healthcare setting.
• Proficiency in data analysis and operational metrics; experience with relevant software/tools (e.g., claims management systems, data visualization platforms).
• Ability to work independently and collaboratively in a fast-paced, client-focused environment.
• Experience working with or leading global teams.
• Exceptional problem-solving and analytical skills.
• Excellent communication and presentation abilities.
• Leadership experience, including team management and project oversight.
• Familiarity with reimbursement innovation, value-based care models and payer-provider alignment strategies.

Benefits

• Continuous learning and professional development opportunities.
• Access to a diverse and vibrant global community.
• Involvement in meaningful and innovative projects.
• Support for growing tech stack, sales skills, and certifications.