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Health Industries – Payer Service Ops – Director

PwC

This is a Full-time position in Detroit, MI posted August 8, 2021.

A career within Operations Strategy services, will provide you with the opportunity to help organisations reimagine their operations through a strategic lens to turn complexity into a competitive advantage.

Our focus is to help our clients create differentiating capabilities that drive competitive advantages by developing plans to navigate their challenges, seeing what’s possible, and turning that into a reality.

We assist our clients in transforming operations from the way they engage their customers to executing strategic programmes to achieve enterprise wide operational excellence.

To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level.

To help us achieve this we have the PwC Professional; our global leadership development framework.

It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.

As a Director, you’ll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution.

PwC Professional skills and responsibilities for this management level include but are not limited to:
Support team to disrupt, improve and evolve ways of working when necessary.Arrange and sponsor appropriate assignments and experiences to help people realise their potential and support their long-term aspirations.Identify gaps in the market and spot opportunities to create value propositions.Look for opportunities to scale efficiencies and new ways of working across multiple projects and environments.Create an environment where people and technology thrive together to accomplish more than they could apart.I promote and encourage others to value difference when working in diverse teams.Drive and take ownership for developing connections that help deliver what is best for our people and stakeholders.Influence and facilitate the creation of long-term relationships which add value to the firm.Uphold the firm’s code of ethics and business conduct.
Minimum Degree Required: Bachelor Degree

Minimum Years of Experience: 7 year(s)

Preferred Qualifications: Degree Preferred, Masters Degree

Preferred Knowledge/Skills:

Demonstrates intimate knowledge of, and/or success in operations roles within a professional services firm or corporate environment, helping companies to identify, clarify and resolve complex issues critical to their strategic and operating success.

Demonstrates intimate knowledge of, and proven success in:

Payer operations strategy
– Sales, Marketing, Benefits/Products, Clinical Management, and Core Operations (Enrollment, Claims, Billing, and Customer Service)

Domain expertise
– Data & Analytics, Automation, Artificial Intelligence, Health Advocacy, Medical Trend Analysis, and Cost Benchmarking.
Government Programs Experience with Medicare Advantage and Medicaid program requirements such as:
Program implementation, product/market expansion and Growth

Program compliance, risk and regulatory compliance

Experience with Risk Adjustment programs and methodologies, experience with quality programs and provider network design.

Business Development
– growing existing clients and developing new clients within the Payor sector
Payer industry market trends and industry-leading practices in order to develop insights and provide recommendations.
Demonstrates a high level of leadership, strategic and creative thinking, problem solving, individual initiative, and the following abilities:
– Leading teams to generate a vision and creating an atmosphere of trust, leveraging diverse views and encouraging improvement and innovation
– Building productive and collaborative relationships with team members and proactively providing and seeking guidance, clarification and feedback
– Leading a team to a successful project conclusion through problem solving complex operations issues
– Managing the planning, organizing and delivery of operations tasks and projects, overseeing independent analyses and ensuring the quality of client deliverables
– Leading the development and improvement of various frameworks and methodologies within operations
– Identifying and addressing client needs: building, maintaining, and utilizing networks of client relationships
– Communicating effectively in an organized and knowledgeable manner in written and verbal formats
– Leveraging quantitative analyses to construct analytical frameworks and synthesize complex data into meaningful insights.