- Payer : We work with clients to bring operational and performance improvement in their core Payer functions with the help of our deep understanding of core functional areas. We help in designing the future operating model, payment model, growth strategy, and functional/technical transformation, Business transformation. Our services span across operational performance improvement including benchmarking, process mapping and design, operating model design, project management, data and analytics strategy, technology effectiveness assessments and market strategy
- Provider : We work with health systems to develop, design, and implement organizational transformation to improve performance and generate lasting growth. Our services span across operational performance improvement including labor and productivity assessments, portfolio rationalization, benchmarking, process mapping and design, operating model design, project management, technology effectiveness assessments and market strategy
- Pharma & Life Sciences : We help clients in R&D and commercial domains. Our services span across launch & commercial planning, portfolio optimization, performance management, R&D innovation, product development, product lifecycle management, risk / compliance, internal audit, risk assessment, management and control.
- Strong understanding of the US healthcare payer functions, specifically around payer back office
- Process experience in one or more of the following areas - claims processing, member enrollment, billing, provider data and related functions
- Experience in delivering results to drive growth across operational, IT and strategic initiatives related to the above functions.
- Knowledge of US Healthcare payer capabilities, specifically around medical & administrative cost optimization, claims and payment integrity, utilization management, care coordination
- Experience in one of more of the following areas - business process mapping and design, operating model, project management, benchmarking, technology assessments, market strategy, workforce management and IT operating model
- Analytical mindset with strong quantitative and problem solving skills
- Understanding of the relevant techno-functional landscape
- Ability to perform primary and secondary research independently.
- Delivering business results through strategic and innovative thinking, problem solving, and individual initiative
- Ability to perform cost benefit analysis to evaluate the potential returns across both digital and traditional initiatives
- Conducting quantitative and qualitative benchmarking
- Ability to conduct analysis of large and complex data
- Foundational knowledge of SAS/SQL and process automation tools (eg., UIPath, Alteryx)
- Experience in digital transformation, enterprise analytics enablement and cloud migration for healthcare payers
- Strong understanding of the US healthcare payer functions, specifically around Medicare Advantage and Medicaid programs
- Working experience in payer quality programs (e.g., STARs, CAHPS, HEDIS) program
- Understanding of key capabilities that drive quality performance and its impact on a healthcare payer in US
- Familiar with provider and member engagement strategies
- Experience with quality programs, and methodologies
- Understanding of program compliance, risk and regulatory compliance
- Payer industry market trends and industry-leading practices in order to develop insights and provide recommendations.
- Analytical mindset with strong quantitative and problem solving skills
- Understanding of the relevant techno-
- functional landscape
- Ability to perform primary and secondary research independently
- Delivering business results through strategic and innovative thinking, problem solving, and individual initiative
- Ability to perform cost benefit analysis to evaluate the potential returns across both digital and traditional initiatives
- Ability to perform cost benefit analysis to evaluate the potential returns across both digital and traditional initiatives
- Conducting quantitative and qualitative benchmarking
- Ability to conduct analysis of large and complex data
- Foundational knowledge of SAS/SQL and process automation tools (eg., UIPath, Alteryx)
- Communicating effectively in written and verbal formats to various situations and audiences
- Compelling storytelling through creative presentation and powerful visualization (including Tableau, PowerBI)
- Hypothesis based problem solving with abstract/limited data
- Proficiency in Microsoft Office Suite of tools
- Demonstrates flexibility in adapting to changing client/business needs
- Flexibility to work across multiple sectors
- Demonstrates ability to work in a global delivery model
- Degree Preferred: MBA/MHA from a premier B-School; US Healthcare knowledge including Healthcare certifications will be an added benefit.
- Level: Experienced Associate
- Function: Payer
- Experience: 24 to 36 months of work experience
- Time Type: Full time
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Health Transformation - Bengaluru, India - PricewaterhouseCoopers Service Delivery Center (Bangalore) Private Limited
Description
Description
& SummaryA career in our Advisory Acceleration Centre is the natural extension of PwC's leading class global delivery capabilities. We provide premium, cost effective, high quality services that support process quality and delivery capability in support for client engagements.JOB OVERVIEW
PwC US ADVISORY – MANAGEMENT CONSULTING
Our Management Consulting team works with our global clients to design and implement growth, operational and customer focused strategies for sustainable competitive advantage. Our thought leadership and unparalleled experience help clients turn formidable challenges into market advantage across the value chain and around the globe. Additionally, our extensive expertise in various industries allow us to serve clients with consulting services with a focus on the most profitable elements of the value chain to create scalable businesses that will deliver increased sustainable profits.
Our Management Consultants work with the client and project teams to support global engagements from India through activities that are driven towards delivering results- conduct analyses and develop insights, prepare excel models, analyze large sets of data, capture as-is processes, prepare work plans, design to-be processes, support project lead, work directly with client teams and facilitate meetings to enable decision making, organize and prepare recommendations on client issues, and participate actively in new business development, thought leadership and firm building activities.
COMPETENCY OVERVIEW: HEALTH TRANSFORMATION (HT)
The HT team works with clients across healthcare, supporting engagements in driving client's strategic vision and objectives, assessing market expansion and growth strategies, researching key market trends and its impact on key stakeholders, driving operational and process improvements, evaluating sustainable cost transformation alternatives and enabling technology driven business success.
Our consultants work to provide a range of client solutions across the following areas:
Capability - Healthcare Back Office Transformation
Knowledge - Essential
Knowledge - Preferred
Skill Set - Essential
Skill Set - Preferred
Capability - Healthcare Quality Management (STARs)
Knowledge - Essential
Knowledge - Preferred
Skill Set - Essential
Skill Set - Preferred
Additional skill sets applicable across capability areas:
Educational Background:
Additional Information:
Education
Degrees/Field of Study required:Degrees/Field of Study preferred:Certifications
Required Skills
Optional Skills
Desired Languages
Travel Requirements
0%Available for Work Visa Sponsorship?
NoGovernment Clearance Required?
YesJob Posting End Date
May 24, 2024