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Payer Operations Senior Associate
Line of Service Advisory
Health Industries
IL-Chicago
81-100%
Full Time
27079BR
Are you interested in the opportunity to work for an industry-leading firm that services Fortune 500 companies, and will give you the experience and exposure you need to build your career? If you are, then PricewaterhouseCoopers LLP (www.pwc.com/us) is the firm for you. PricewaterhouseCoopers LLP (PwC US) is well placed to help clients meet the challenges and opportunities of the US marketplace in the areas of assurance, tax, and advisory. We offer the perspective of being part of a global network of firms combined with detailed knowledge of local, state and US national issues. More than 169,000 people in over 158 countries across the PwC network are committed to deliver quality in assurance, tax and advisory services. People across the PwC network share knowledge, experience and solutions to develop fresh perspectives and deliver practical advice.
At PwC US, you will be part of a learning culture, where teamwork and collaboration are encouraged, excellence is rewarded, and diversity is respected and valued. We offer a flexible career progression model that allows for a variety of challenging opportunities throughout your career. We provide unparalleled coaching, mentoring, and career development programs; global opportunities; and state of the art technology-driven methodologies to help you provide quality service to our clients.
At PwC US, you will find Advisory professionals with unparalleled financial and accounting expertise, knowledge of business processes, industry insight and technology, and customer relationship skills. Our Advisory professionals help companies anticipate, create and manage change. In short, we help companies to: (1) respond to crises, (2) improve business processes, and (3) transform their business. Note that across all of these solutions, we embed sustainability into our approach. This also includes helping clients to sustain prior changes that may have been undertaken to address a crisis.
Members of our PwC US Advisory practice provide a valuable service to our clients and strive to differentiate PwC by executing the following:
We put our clients first: Each client situation is unique, and we tailor our approach to every relationship and engagement;
We view the world from a client's perspective: From the initial client meeting onward, we listen first, and then assemble a hand-picked team from across the firm;
We create lasting value for our clients: We bring together the precision, structure, and deep analytical capabilities of audit and tax and the creative mindset and problem-solving skills of consulting; and
We focus on action, impact, and value: We don't just assess and recommend; we also help our clients implement with agility and flexibility.
The Health Industries practice comprises professionals with deep health industry expertise, including physicians, nurses, information system specialists, health policy analysts, actuaries, financial advisors, and data analysts. Their multidisciplinary and multi-industry approach enables our professionals to collaborate with clients to help them manage strategic initiatives, deliver financial performance and operational improvements, manage risk and compliance programs and to align core business processes with health information technology.
With a focus toward capabilities in innovation and growth, operations improvement, sustainability and quality, information technology, financial management, and governance, risk, and compliance, the practice has served clients in the following sectors:
Healthcare providers: hospitals, health systems, academic medical centers, community providers, outpatient and freestanding ambulatory centers, and physician practices
Payers: focused on both commercial health plans and public governmental insurers
Employers: this area works with corporations from a broad range of industries concerned about employee healthcare coverage and costs
Pharmaceutical companies: branded and generic manufacturers and drug research organizations
Life sciences companies: biotech, diagnostic and medical device organizations
The Health Industries strategy focuses on our capabilities and bandwidth in the following areas: Health Information Technology, Risk and Regulatory, Personalized Medicine, Pharma and Life Sciences Research and Development and Sales and Marketing, and Medical Device.
Organizations are seeking new planning and performance management solutions to aid decision making. Successfully implementing a new performance management program requires an approach that flows from a strategic plan, measures progress against carefully defined goals and rewards employees for behavior and actions that meet those goals and support the strategy.
At PricewaterhouseCoopers, our approach enables organizations to integrate their financial and non-financial systems and processes to achieve sustainable improvements in performance. As a valued member of the team, you will help clients:
• Create effective corporate performance management tools
• Design and build robust business intelligence systems
• Identify the most appropriate measures of your financial, operational and regulatory performance
• Increase the efficiency and frequency of client reporting processes
• Improve the reliability of prospective information, including budgets and rolling forecasts
• Develop corporate scorecards to evaluate client performance and drive improvements; and
• Link client organizational targets with their employee evaluation and remuneration policies to ensure lasting change.
At PricewaterhouseCoopers LLP, we are advisors and consultants to the largest service business on the globe: Healthcare. We bring intellectual capital from around the world to develop solutions for clients' most complex business problems. We provide a broad range of consulting and business advisory services to health plans, physician practices, hospitals, higher education, pharmaceutical, biotech and medical device companies. We help our clients improve operational efficiency, financial performance and IT effectiveness.
This position will work with payer organizations including large national companies, and regional and local plans, to identify performance improvement opportunities across all operational areas.
Knowledge Preferred:
Selected individuals will have demonstrated knowledge and direct experience with the following:
Corporate Strategy: Growth strategy, Customer Experience strategy, or Financial Strategy in the health care field
Government Programs: Medicare Advantage, Medicaid, TriCare, enrollment, claims, billing and payments (provide and health plan), regulatory compliance and remediation
Finance and Operations: process improvement, Health Reform, ICD-10, membership, medical claims, billing, reimbursement structures, data analytics, project/program management, technology assessment/planning/implementation
Clinical Management: Care, disease, and/or utilization management, coding
Product Management: Market strategy and competitive intelligence, product development, sales channel development and management
Skills Preferred:
- Proven ability to work independently and lead small teams on specific projects
- Demonstrated thorough presentation skills, both verbal and written, utilizing technologies such as MS PowerPoint, MS Word, MS Excel, MS Visio, MS Access
- Proven ability to utilize creative problem solving skills and contribute to innovative solutions when working on client-related healthcare projects
- Demonstrated experience coaching junior staff
Min Year Exp:
Minimum of 3 years consulting or industry experience in Health Plan Strategy or Operations required
Min Degree(s) and Certifications:
Bachelor of Science or Bachelor of Arts degree required
Position requires up to 100% travel.
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