Health Payer Operations Manager; Claims Operations

Overview

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 750,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships.

We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships.

360° value is measured by the impact we create for clients, colleagues, shareholders, partners and communities. Visit us at

As a Health Payer Operations Manager/Consultant, your primary responsibilities may include:

• Claims Operations
• 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.
• Transform traditional operating models and processes to incorporate innovative designs with advanced technologies.
• Ensure compliance with all regulatory requirements and payer policies across claims operations.
• Partner with Technology teams to shape claims platform configuration and optimization.
• Strategic Operations & Improvement 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.
• Design and operationalize KPI and performance management frameworks to monitor claims health and support executive decision-making.
• Stakeholder Management & Collaboration
• 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.
• Contribute to Health Administration consulting practice by mentoring junior team members, maintaining currency on industry events and trends, and developing thought leadership on emergent trends.
• Compliance & Risk Management
• 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.
• Proactively identify risk as part of consulting engagements and frame mitigation strategies in partnership with project leadership.
• Leading Transformational Change
• Lead large-scale transformation initiatives in health payer operations, focusing on streamlining processes, enhancing service delivery, and achieving operational excellence.
• Drive transformational change and lead change initiatives that require a deep understanding of functional processes, combined with the ability to navigate across business domains and align with emerging technologies.
• Develop value architecture spanning baseline and target state metrics supported by defined capabilities driving value informed by best practices

As needed, up to 80%.

• Innovate every day. Be at the forefront of designing health technology solutions that push boundaries and create new opportunities for our clients.
• Lead with the industry’s best. Join an industry-recognized healthcare…