Health Payer Operations Associate Director

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.

As a Health Payer Operations Associate Director, your primary responsibilities may include:

1. 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.

Why should I join the Accenture Health team?

1. Innovate every day. Be at the forefront of designing health technology solutions that push boundaries and create new opportunities for our clients.
2. 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.
3. Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health, consultative and delivery skills.

Here’s what you need:

1. Bachelor’s degree in Healthcare Administration, Business, or related field.
2. 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.
3. Minimum of 10 years of experience leading transformation initiatives, streamlining processes, and implementing data-driven solutions.
4. Minimum of 10 years of experience working with senior leaders and cross-functionally to achieve objectives, demonstrating excellent interpersonal and communication skills.
5. 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).
6. Minimum of 10 years of experience working independently and collaboratively in a fast-paced, client-focused environment.

Bonus points if:

1. Master's degree preferred.
2. Experience working with or leading global teams.
3. Exceptional problem-solving and analytical skills.

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.

At Accenture, you will be able to work on meaningful and innovative projects, powered by the latest technologies and industry best practices.

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