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Health Consulting | Payer Operations Associate Director

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 Associate Director , your primary responsibilities may include: 

Leading Transformational Change

• Lead process improvement initiatives across benefits, membership, claims and provider operations, implementing data-driven solutions to enhance efficiency and effectiveness.

• Utilize analytics and operational performance metrics to monitor progress, identify trends, and drive data-informed decision-making for continuous improvement.

• Spearhead large-scale transformation projects focused on streamlining operation al processes, improving service delivery, and achieving operational excellence.

• Lead organizational change initiatives, leveraging a deep understanding of functional processes, technology integration, and cross-functional alignment to enhance operational performance.

• Promote a culture of continuous improvement by fostering innovation and embracing new technologies in claims management.

  Claims Operations Improvement

• Lead and manage projects to improve claims processing efficiency and accuracy, ensuring timely and accurate processing while maintaining a focus on cost efficiency.

• Analyze and optimize claims workflows, identifying bottlenecks and areas for automation .

• Ensure compliance with all relevant state and federal health payer regulations, payer policies, and contractual agreements across claims operations.

  Provider/Network Operations Improvement

• Oversee projects aimed at optimizing provider network operations, with a focus on enhancing provider onboarding, credentialing, contracting, and ensuring directory accuracy.

• Collaborate closely with provider network teams to improve provider experience and meet network adequacy, accessibility, and quality standards.

• Evaluate and refine provider relations and contracting processes to support payer-provider alignment, including the integration of value-based care initiatives.

  Team Leadership and Collaboration

• Collaborate with client teams, including IT, compliance, and customer service, to ensure alignment of operations with broader organizational priorities and objectives .

• Communicate effectively with senior client leadership by providing regular status reports, presenting key insights, and driving strategic discussions.

• Serve as a subject matter expert for operations, offering guidance and mentorship to junior team members and consultants.

  Compliance & Risk Management:

• Stay up to date with evolving healthcare regulations and payer policies to ensure ongoing compliance within claims operations and network management.

• Proactively identify and mitigate risks withi n membership, claims and network operations, ensuring the organization is prepared to address regulatory and operational challenges.

  Travel - as needed, up to 80%

    Why should I join the Accenture Health team?  

•   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 leader with more than 20,000 global healthcare professionals collaborating to drive enterprise-wide transformational projects on a global scale. Accenture has worked with more than 200 clients to deliver healthcare transformation to meet the diverse needs of patients and members .

• Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health , consultative and delivery skills. With learning resources, interactive classroom courses, real-life client simulations and ongoing mentoring available when you need it, you’ll expand your thinking beyond the core Workday implementation. 

  Here’s what you need:  

• Bachelor’s degree in Healthcare Administration , Business, or related field.

• Minimum of 10 years of experience in healthcare consulting or enterprise operations improvement , with a focus on payer operations, claims processing, and/or provider network operations.

• Minimum of 10 years of experience leading transformation initiatives, streamlin ing processes, and implement ing data-driven solutions.

• Minimum of 10 years of experience working w ith senior leaders and cross-functionally to achieve ob jectives , demonstrating excellent interpersonal and communication skills .

• Minimum of 10 years of experience in data analysis , operational metrics , and working with relevant software/tools (e.g., claims management systems, data visualization platforms).

• Minimum of 10 years of experience working independently and collaboratively in a fast-paced, client-focused environment.

  Bonus points if:

• Master's degree preferred.

• Experience working with or leading global teams. 

• Thrive in a diverse, fast paced environment. 

• An advanced degree in the area of specialization.

• Exceptional problem-solving and analytical skills.

• Excellent communication and presentation abilities.

• Leadership experience, including team management and project oversight. 

• Familiarity with reimbursement innovation, value-based car e models and payer-provider alignment strategies.

What’s in it for you?

You will be part of a diverse, vibrant, global Accenture community; teams pushing the boundaries of new business capabilities and emerging technologies and services, sharing their experiences and lessons learned with each other. You’ll have the chance to thrive in an environment where your ideas are valued and your voice matters.

At Accenture, you will be able to work on meaningful and innovative projects, powered by the latest technologies and industry best practices such as event-driven architectures and domain driven design.

Accenture will continually invest in your learning and growth. You'll learn from and work with Accenture’s certified practitioners and Accenture will support you in growing your own tech stack, sales skills, and certifications.

You'll be immersed in the design and implementation of human-centric solutions to help solve complex challenges with some of the world’s largest companies.

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Illinois, Maryland, Minnesota, New York or Washington as set forth below.We accept applications on an on-going basis and there is no fixed deadline to apply.

Information on benefits is here. (https://www.accenture.com/us-en/careers/local/total-rewards)

Role Location Annual Salary Range

California $163,000 to $434,000

Colorado $163,000 to $375,000

District of Columbia $173,500 to $399,300

Illinois $150,900 to $375,000

Minnesota $163,000 to $375,000

Maryland $150,900 to $347,200

New York $150,900 to $434,000

Washington $173,500 to $399,300

What We Believe

We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.

Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here (https://www.accenture.com/us-en/about/inclusion-diversity/us-workforce)

Equal Employment Opportunity Statement

Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Accenture is committed to providing veteran employment opportunities to our service men and women.

For details, view a copy of the Accenture Equal Employment Opportunity and Affirmative Action Policy Statement (https://www.accenture.com/content/dam/accenture/final/accenture-com/document/Annual-Policy-Statement-Regarding-EEO-2023-Applicant.pdf#zoom=50) .

Requesting An Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email (https://www.accenture.com/us-en/about/contact-us) or speak with your recruiter.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.