Experienced Associate - Payer - Health Transformation

Line of Service

Industry/Sector

Specialism

Management Level

Job Description & Summary

JOB OVERVIEW 

PwC US ADVISORY – MANAGEMENT CONSULTING

Our Management Consulting team works with our global clients to design and implement growth, operational and customer focused strategies for sustainable competitive advantage. Our thought leadership and unparalleled experience help clients turn formidable challenges into market advantage across the value chain and around the globe. Additionally, our extensive expertise in various industries allow us to serve clients with consulting services with a focus on the most profitable elements of the value chain to create scalable businesses that will deliver increased sustainable profits. 

Our Management Consultants work with the client and project teams to support global engagements from India through activities that are driven towards delivering results- conduct analyses and develop insights, prepare excel models, analyze large sets of data, capture as-is processes, prepare work plans, design to-be processes, support project lead, work directly with client teams and facilitate meetings to enable decision making, organize and prepare recommendations on client issues, and participate actively in new business development, thought leadership and firm building activities.

COMPETENCY OVERVIEW: HEALTH TRANSFORMATION (HT)

The HT team works with clients across healthcare, supporting engagements in driving client’s strategic vision and objectives, assessing market expansion and growth strategies, researching key market trends and its impact on key stakeholders, driving operational and process improvements, evaluating sustainable cost transformation alternatives and enabling technology driven business success. 

Our consultants work to provide a range of client solutions across the following areas: 

• Payer: We work with clients to bring operational and performance improvement in their core Payer functions with the help of our deep understanding of core functional areas. We help in designing the future operating model, payment model, growth strategy, and functional/technical transformation, Business transformation. Our services span across operational performance improvement including benchmarking, process mapping and design, operating model design, project management, data and analytics strategy, technology effectiveness assessments and market strategy
• Provider: We work with health systems to develop, design, and implement organizational transformation to improve performance and generate lasting growth. Our services span across operational performance improvement including labor and productivity assessments, portfolio rationalization, benchmarking, process mapping and design, operating model design, project management, technology effectiveness assessments and market strategy 
• Pharma & Life Sciences: We help clients in R&D and commercial domains. Our services span across launch & commercial planning, portfolio optimization, performance management, R&D innovation, product development, product lifecycle management, risk / compliance, internal audit, risk assessment, management and control. 

Capability - Healthcare Back Office Transformation

Knowledge - Essential

• Strong understanding of the US healthcare payer functions, specifically around payer back office
• Process experience in one or more of the following areas - claims processing, member enrollment, billing, provider data and related functions
• Experience in delivering results to drive growth across operational, IT and strategic initiatives related to the above functions.

Knowledge - Preferred

• Knowledge of US Healthcare payer capabilities, specifically around medical & administrative cost optimization, claims and payment integrity, utilization management, care coordination
• Experience in one of more of the following areas - business process mapping and design, operating model, project management, benchmarking, technology assessments, market strategy, workforce management and IT operating model

Skill Set - Essential

• Analytical mindset with strong quantitative and problem solving skills
• Understanding of the relevant techno-functional landscape
• Ability to perform primary and secondary research independently.
• Delivering business results through strategic and innovative thinking, problem solving, and individual initiative
• Ability to perform cost benefit analysis to evaluate the potential returns across both digital and traditional initiatives

Skill Set - Preferred

• Conducting quantitative and qualitative benchmarking
• Ability to conduct analysis of large and complex data
• Foundational knowledge of SAS/SQL and process automation tools (eg., UIPath, Alteryx)
• Experience in digital transformation, enterprise analytics enablement and cloud migration for healthcare payers

Capability - Healthcare Quality Management (STARs)

Knowledge - Essential

• Strong understanding of the US healthcare payer functions, specifically around Medicare Advantage and Medicaid programs 
• Working experience in payer quality programs (e.g., STARs, CAHPS, HEDIS) program 
• Understanding of key capabilities that drive quality performance and its impact on a healthcare payer in US
• Familiar with provider and member engagement strategies

Knowledge - Preferred

• Experience with quality programs, and methodologies
• Understanding of program compliance, risk and regulatory compliance
• Payer industry market trends and industry-leading practices in order to develop insights and provide recommendations.

Skill Set - Essential

• Analytical mindset with strong quantitative and problem solving skills
• Understanding of the relevant techno-
• functional landscape
• Ability to perform primary and secondary research independently
• Delivering business results through strategic and innovative thinking, problem solving, and individual initiative
• Ability to perform cost benefit analysis to evaluate the potential returns across both digital and traditional initiatives
• Ability to perform cost benefit analysis to evaluate the potential returns across both digital and traditional initiatives

Skill Set - Preferred

• Conducting quantitative and qualitative benchmarking
• Ability to conduct analysis of large and complex data
• Foundational knowledge of SAS/SQL and process automation tools (eg., UIPath, Alteryx)

Additional skill sets applicable across capability areas:  

• Communicating effectively in written and verbal formats to various situations and audiences
• Compelling storytelling through creative presentation and powerful visualization (including Tableau, PowerBI)
• Hypothesis based problem solving with abstract/limited data
• Proficiency in Microsoft Office Suite of tools
• Demonstrates flexibility in adapting to changing client/business needs
• Flexibility to work across multiple sectors
• Demonstrates ability to work in a global delivery model 

Educational Background:  

• Degree Preferred: MBA/MHA from a premier B-School; US Healthcare knowledge including Healthcare certifications will be an added benefit. 

Additional Information:

• Level: Experienced Associate
• Function: Payer
• Experience: 24 to 36 months of work experience 
• Time Type: Full time

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

Certifications (if blank, certifications not specified)

Required Skills

Optional Skills

Desired Languages (If blank, desired languages not specified)

Travel Requirements

Available for Work Visa Sponsorship?

Government Clearance Required?

Job Posting End Date