Health Payer Operations Manager (Claims Operations)

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 .

Strategy & Consulting: We work with C-suite executives, leaders and boards of the world's leading organizations, helping them reinvent every part of their enterprise to drive greater growth, enhance competitiveness, implement operational improvements, reduce cost, deliver sustainable 360° stakeholder value, and set a new performance frontier for themselves and the industry in which they operate. Our deep industry and functional expertise is supported by proprietary assets and solutions that help organizations transform faster and become more resilient. Underpinned by technology, data, analytics, AI, change management, talent and sustainability capabilities, our Strategy & Consulting services help architect and accelerate all aspects of an organization's total enterprise reinvention.

As a Health Payer Operations Manager /Consultant , your primary responsibilities may include:?

• Claims Operations

• Lead initiatives to improve claims processing efficiency and accuracy, reducing operational costs and improving member satisfaction.

• Analyze claims workflows and identify bottlenecks or opportunities for automation to streamline processes.

• Transform traditional operating models and process to incorporate innovative designs with advanced technologies

• Ensure compliance with all regulatory requirements and payer policies across claims operations.

• Partner with Technology teams to shape claims platform configuration and optimization

• Strategic Operations & Improvement Initiatives

• Develop, implement, and monitor process improvement initiatives across claims and provider operations.

• Utilize data analytics and operational metrics to identify trends, monitor performance, and recommend adjustments as needed.

• Lead training and support change management efforts for new initiatives to ensure smooth transitions and process adoption.

• Design and operationalize KPI and performance management frameworks to monitor claims health and support executive decision-making.

• Stakeholder Management & Collaboration

• Partner with internal teams (e.g., IT, compliance, customer service) to ensure project goals align with organizational priorities.

• Communicate effectively with senior leadership, providing regular updates and progress reports.

• Serve as a subject matter expert and provide guidance to junior consultants or team members.

• Contribute to Health Administration consulting practice by mentoring junior team members, maintain currency on industry events and trends as well as develop thought leadership to advance industry perspectives on emerging trends.

• Compliance & Risk Management

• Maintain current knowledge of state and federal health payer regulations and ensure compliance across all operational activities.

• Identify and mitigate operational risks within claims and network operations.

• Proactively identify risk as part of consulting engagements and frame mitigation strategies in partnership with project leadership.

• Leading Transformation al Change

• Lead large-scale transformation initiatives in health payer operations, focusing on streamlining processes, enhancing service delivery, and achieving operational excellence.

• Drive transformational change and lead change initiatives that require a deep understanding of functional processes, combined with the ability to navigate across business domains and align with emerging technologies.

• Develop value architecture spanning baseline and target state metrics supported by defined capabilities driving value informed by best practices

  Travel

• As needed, up to 80%

Why should I join the Accenture Health team? ?

• Innovate every day. Be at the forefront of designing health technology solutions that push boundaries and create new opportunities for our clients.?

• 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. Accenture has worked with more than 200 clients to deliver healthcare transformation to meet the diverse needs of patients and members .

• Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health , consultative and delivery skills. With learning resources, interactive classroom courses, real-life client simulations and ongoing mentoring available when you need it, you'll expand your thinking beyond the core Workday implementation.?

Here's what you need: ?

• Bachelor's degree in Healthcare Administration , Business, or related field.

• Minimum of 3 years of experience in healthcare consulting or enterprise operations improvement , with a focus with payer and/or provider clients.

• Minimum of 3 years of experience in health payer operations, particularly in claims and/or provider network operations.

• 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.?

• Experience in creating and delivering agentic AI solutions for Claims or other Operations functions

• Experience with industry leading claim adjudication platforms and related technology, and payment integrity vendors.

• Strong knowledge of health insurance regulatory requirements, payer policies, and claims adjudication.

• Proven experience leading and executing process improvement projects in a healthcare setting.

• Proficiency in data analysis and operational metrics; experience with relevant software/tools (e.g., claims management systems, data visualization platforms).

• Ability to work independently and collaboratively in a fast-paced, client-focused environment.

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 as set forth below.We anticipate this job posting will be posted until 03/27/2026.

Accenture offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off. See more information on our benefits here:

U.S. Employee Benefits | Accenture ()

Role Location Annual Salary Range

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

Requesting an Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs such as for a disability or religious observance, please call us toll free at 1 (877) 889-9009 or send us an email or speak with your recruiter.

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences.?All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.?Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.

For details, view a copy of the?Accenture Equal Opportunity Statement ()

Accenture is an EEO and Affirmative Action Employer of Veterans/Individuals with Disabilities.

Accenture is committed to providing veteran employment opportunities to our service men and women.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process. Further, at Accenture a criminal conviction history is not an absolute bar to employment.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

California requires additional notifications for applicants and employees. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, please click here for additional important information.

Please read Accenture's Recruiting and Hiring Statement for more information on how we process your data during the Recruiting and Hiring process.