Accenture
Health Payer Operations Associate Director
Accenture, Boston, Massachusetts, us, 02298
Accenture is a leading global professional services company that helps the world’s leading businesses, governments, and other organizations build their digital core, optimize their operations, accelerate revenue growth, and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 750,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data, and AI with unmatched industry experience, functional expertise, and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions, and assets across Strategy & Consulting, Technology, Operations, Industry X, and Song. These capabilities, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners, and communities. Visit us at
www.accenture.com . 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 operational 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 within membership, claims, and network operations, ensuring the organization is prepared to address regulatory and operational challenges.
Travel - as needed, up to 80% 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, streamlining processes, and implementing data-driven solutions. Minimum of 10 years of experience working with senior leaders and cross-functionally to achieve objectives, 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 care 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. 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. 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.
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www.accenture.com . 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 operational 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 within membership, claims, and network operations, ensuring the organization is prepared to address regulatory and operational challenges.
Travel - as needed, up to 80% 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, streamlining processes, and implementing data-driven solutions. Minimum of 10 years of experience working with senior leaders and cross-functionally to achieve objectives, 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 care 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. 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. 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.
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