Health Payer Operations Lead

Join Accenture, a top-tier global professional services company, as we help businesses, governments, and organizations drive transformative change. With a focus on technology, we leverage our extensive talent and innovation to deliver exceptional results at scale. Our combination of cloud, data, and AI expertise positions us uniquely to foster growth, improve operations, and enhance overall service delivery. As part of Accenture's dedication to building lasting relationships, we create 360° value for our clients, our teams, and the communities we serve. As a Health Payer Operations Lead, you will play a vital role in: Claims Operations Driving initiatives to enhance claims processing efficiency and accuracy while reducing operational costs and improving member satisfaction. Analyzing claims workflows to identify bottlenecks and opportunities for automation, streamlining operations. Transforming traditional operational models by incorporating innovative designs with advanced technologies. Ensuring compliance with all regulatory requirements and payer policies throughout claims operations. Collaborating with technology teams to optimize claims platform configurations and functionalities. Strategic Operations & Improvement Initiatives Developing, implementing, and monitoring process improvement strategies within claims and provider operations. Utilizing data analytics to identify trends, monitor performance, and drive necessary adjustments. Leading training and change management activities to facilitate smooth transitions and encourage process adoption. Designing and operationalizing key performance indicators (KPIs) to measure claims health and guide executive decision-making. Stakeholder Management & Collaboration Engaging with internal teams (e.g., IT, compliance, customer service) to align project objectives with organizational priorities. Providing senior leadership with regular updates and progress reports. Acting as a subject matter expert to mentor junior consultants and team members. Contributing to the Health Administration consulting practice through mentorship and thought leadership. Compliance & Risk Management Staying informed about state and federal health payer regulations to ensure compliance across operations. Identifying and mitigating operational risks within claims and network operations. Proactively identifying potential risks during consulting engagements and framing mitigation strategies with project leadership. Driving Transformational Change Leading large-scale transformation initiatives in health payer operations aimed at streamlining processes and enhancing service delivery. Driving change initiatives that align functional processes with emerging technologies. Creating value architecture that defines baseline and target state metrics informed by industry best practices. Travel: Willingness to travel as needed, up to 80%. Why Join Accenture Health? Innovate daily by designing health technology solutions that expand possibilities for our clients. Work alongside industry leaders in healthcare, collaborating with over 20,000 experts on transformational projects on a global scale. Continuously learn and grow through comprehensive training and professional development programs. Qualifications: Bachelor's degree in Healthcare Administration, Business, or a related field. A minimum of 3 years of experience in healthcare consulting or operational improvements, focusing on payer/provider clients. A minimum of 3 years of experience in health payer operations, specifically in claims and/or provider network operations. Bonus qualifications: Master's degree preferred. Experience working with or leading global teams. A commitment to thriving in a diverse, fast-paced environment. Proficient problem-solving and analytical skills. Excellent communication and presentation skills. Strong leadership experience in team management and project oversight. Experience with AI solutions for Claims or Operations functions. Familiarity with industry-leading claims adjudication platforms and technology. Comprehensive knowledge of health insurance regulatory requirements and policies. Demonstrated ability in leading process improvement projects in a healthcare setting. Proficiency in data analysis and operational metrics, with relevant software/tool experience. Capability to work independently and collaboratively in a demanding, client-focused environment. Compensation at Accenture varies based on numerous factors, including office location, role, skill set, and experience level. As required by law, Accenture provides a reasonable salary range for this role: California: $94,400 to $293,800 Cleveland: $87,400 to $235,000 Colorado: $94,400 to $253,800 District of Columbia: $100,500 to $270,300 Illinois: $87,400 to $253,800 Maryland: $94,400 to $253,800 Massachusetts: $94,400 to $270,300 Minnesota: $94,400 to $253,800 New York: $87,400 to $293,800 New Jersey: $100,500 to $293,800 Washington: $100,500 to $270,300 Accenture is committed to providing equal employment opportunities and reasonable accommodations for persons with disabilities or religious observances. We encourage applicants with diverse backgrounds and experiences to apply and contribute to our enriching work environment.

Created: 2026-03-04