Experienced Associate - Payer - Health Transformation

Line of Service

Advisory

Industry/Sector

Not Applicable

Specialism

Operations

Management Level

Associate

Job Description & Summary

A career in our Advisory Acceleration Centre is the natural extension of PwCs leading class global delivery capabilities. We provide premium cost effective high quality services that support process quality and delivery capability in support for client engagements.

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 asis processes prepare work plans design tobe 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 clients 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 technofunctional 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 industryleading 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 BSchool; US Healthcare knowledge including Healthcare certifications will be an added benefit.

Additional Information:

• Level: Experienced Associate
• Function: Payer
• Experience: 12 to 36 months of work experience
• Time Type: Full time
• Location: Bangalore (Preferred)

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 Budgetary Management Business Analysis Business Development Business Process Improvement Business Transformation Change Management Communication Customer Relationship Management Customer Strategy Emerging Technologies Emotional Regulation Empathy Financial Management Inclusion Industry Knowledge Industry Trend Analysis Intellectual Curiosity Management Consulting Market Trends Optimism Organizational Development (OD) Organizational Management 8 more

Desired Languages (If blank desired languages not specified)

Travel Requirements

0

Available for Work Visa Sponsorship

No

Government Clearance Required

No

Job Posting End Date