Health Payer Operations Manager; Claims Operations

Position: Health Payer Operations Manager (Claims Operations)
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.

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Strategy & Consulting:
We work with C-suite executives, leaders and boards of the world's leading organizations, helping them reinvent every part of their enterprise to drive greater growth, enhance competitiveness, implement operational improvements, reduce cost, deliver sustainable 360° stakeholder value, and set a new performance frontier for themselves and the industry in which they operate. Our deep industry and functional   expertise   is   supported by proprietary assets and solutions that help organizations transform faster and become more resilient.

Underpinned by technology, data, analytics, AI, change management, talent and sustainability capabilities, our Strategy & Consulting services help architect and accelerate all aspects of an organization's total enterprise reinvention.

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   process   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,   maintain   currency on industry events and trends   as well as   develop   thought leadership to advance   industry   perspectives   on emerging 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  …