BSCO-Experienced Associate - Payer - Health Transformation

Industry/Sector

Not Applicable

Specialism

Operations

Management Level

Associate

Job Description & Summary

A 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: 

• 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. 

Capability - Healthcare Back Office Transformation

Knowledge - Essential

• Strong analytical and problem-solving skills 

• Understanding of core payer operations (enrollment, claims, eligibility etc.) and systems 

• Ability to conduct independent research 

• Strong strategic and structured thinking skills 

• Ability to run simple cost-benefit analyses 

• Basic ability to use GenAI for research and storyboarding 

• Ability to support technology-enabled operating model transformations, including workflow redesign, system implementation, or platform optimization 

Knowledge - Preferred

• Ability to run benchmarking analyses 

• Experience analyzing large and complex datasets 

• Basic knowledge of SQL / automation tools 

• Exposure to digital transformation and analytics initiatives 

• Familiarity with AI/ML, & NLP concepts 

• Familiarity with payer workflows; e.g. benefits, provider data, or credentialing 
• Understanding of payer core platforms and ecosystems (e.g., enroll

Payer Modernization – Healthcare Middle Office Transformation

  Knowledge - Essential

• Strong analytical and problem-solving skills
• Ability to conduct independent research
• Ability to think strategically and drive outcomes
• Ability to perform benchmarking & cost-benefit analyses
• Basic ability to use GenAI for research and storyboarding

Skill Set - Preferred

• Understanding of payer middle office functions (e.g., care management, utilization management, pharmacy management, network management, provider engagement, and payment integrity)
• Experience analyzing large and complex datasets
• Basic knowledge of SQL / automation tools
• General interest in AI, ML, and NLP concepts

Payer Modernization - Payer Analytics and Data Strategy 

Knowledge - Essential

• Proficiency in SQL, R, Python, or similar tools 

• Strong analytical skills to uncover healthcare data insights 

• Ability to support data governance practices 

• Clear communication of technical insights to business teams 

• Experience supporting data-driven initiatives and outcomes 

• Basic ability to use GenAI for research and storyboarding 

• Ability to support risk adjustment, quality, and utilization analytics, including performance monitoring and insight generation 

Skill Set - Preferred

• Exposure to predictive modeling and forecasting techniques 

• Ability to encourage innovation using data-driven ideas 

• General familiarity with AI, ML, and NLP concepts 

• Familiarity with risk scoring, anomaly detection, or payment integrity patterns 

• Exposure to predictive modeling or analytics use cases supporting care management, pharmacy spend, or risk adjustment 

Additional skill sets applicable across capability areas:   

• 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  

Educational Background:   

• Degree Preferred: MBA/MHA from a premier B-School; US Healthcare knowledge including Healthcare certifications will be an added benefit.

• Additional Information: 

• Level: Experienced Associate 

• Function: Payer Modernization 

• Experience: 12 to 36 months of work experience  

• Time Type: Full time  

• Work Timings: Work hours may vary for specific projects 

• Travel Requirements: Travel to client locations may be required as per project requirements 

• Office Location: Bangalore

Travel Requirements

0%

Job Posting End Date