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Health Consulting | Payer Operations Consultant/Manager

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 Consultant/Manager , 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.

• Ensure compliance with all regulatory requirements and payer policies across claims operations.

  Provider/Network Operations

• Manage projects aimed at optimizing provider network operations, including provider onboarding, credentialing, contracting, and directory accuracy.

• Collaborate with network teams to improve provider experience and ensure network adequacy and accessibility standards are met.

• Evaluate provider relations and contracting processes to support payer-provider alignment and value-based care initiatives.

  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.

  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.

  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.

  Leading Transformation al 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.

• 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 3 years of experience in healthcare consulting or enterprise operations improvement , with a focus with payer and/or provider clients.

• Minimum of 3 years of experience in health payer operations, particularly in claims and/or provider network operations.

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Bonus points if:

• Master's degree preferred.

• Strong knowledge of health insurance regulatory requirements, payer policies, and claims adjudication.

• Proven experience leading and executing process improvement projects in a healthcare setting.

• Proficiency in data analysis and operational metrics; experience with relevant software/tools (e.g., claims management systems, data visualization platforms).

• Ability to work independently and collaboratively in a fast-paced, client-focused environment.

• 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.

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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 $63,800 to $293,800

Colorado $63,800 to $253,800

District of Columbia $68,000 to $270,300

Illinois $59,100 to $253,800

Minnesota $63,800 to $253,800

Maryland $59,100 to $235,000

New York $59,100 to $293,800

Washington $68,000 to $270,300

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.