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.