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 their 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.

We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at

• As a Health Payer Operations Manager / Consultant, contribute to claims operations and strategic initiatives within health payer environments.
• Lead initiatives to improve claims processing efficiency and accuracy, reducing costs and improving member satisfaction.
• Analyze claims workflows to identify bottlenecks or opportunities for automation to streamline processes.
• Transform operating models and processes to incorporate innovative designs with advanced technologies.
• Ensure compliance with regulatory requirements and payer policies across claims operations.
• Partner with Technology teams to shape claims platform configuration and optimization.
• 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.
• Lead training and change management efforts for new initiatives to ensure smooth transitions and adoption.
• Design and operationalize KPI and performance management frameworks to monitor claims health and support executive decision-making.
• Collaborate with internal teams (e.g., IT, compliance, customer service) to align project goals 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.
• Mentor junior team members, stay current on industry events and trends, and contribute to thought leadership on emerging trends in health administration consulting.
• Identify and mitigate operational risks within claims and network operations; proactively identify risk and frame mitigation strategies with project leadership.
• Lead large-scale transformation initiatives in health payer operations, focusing on streamlined processes, enhanced service delivery, and operational excellence.
• Drive transformational change and lead initiatives that require deep understanding of functional processes and collaboration across business domains with emerging technologies.
• Develop value architecture spanning baseline and target state metrics supported by defined capabilities driving value.
• Travel may be required up to 80% as needed.

• Bachelor’s degree in Healthcare Administration, Business, or related field.
• Minimum of 3 years of experience in healthcare consulting or enterprise operations improvement, focusing on payer and/or provider clients.
• Minimum of 3 years of experience in health payer operations, particularly in claims and/or provider network operations.
• Master's degree preferred (bonus points).
• Experience working with or leading global teams.
• Ability to thrive in a diverse, fast-paced environment.
• Advanced degree in the area of specialization.
• Exceptional problem-solving and analytical skills; strong communication and presentation abilities.
• Leadership experience, including team…