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.