Payer Middle Office / Technology / Operations Consultant, Senior Manager

The Opportunity

As a Payer Middle Office / Technology / Operations Consultant you will advise health payer clients on modernizing operations and platforms across core systems and customer-facing functions, within our Advisory practice. As a Senior Manager you will lead large projects, shape process improvements, apply sound judgment in complex settings, and guide diverse teams through change while drawing on your knowledge of business and supply chain operations, payer modernization, and health services.

In this role at PwC, you will help drive work across payer core operations, payer core technology, and front and middle office operations, with focus areas that may include claims processing, reimbursement models, government program support, core platform execution, care and utilization management, digital experience, and customer growth. You will bring a client-facing perspective to work that connects strategy, technology, and operations, with exposure to platforms such as Oracle OHI, Epic, Facets, and Nasco.

Responsibilities

• Advising payer clients on modernization of middle office operations, core technology, and operating models across claims, reimbursement, care management, and customer service functions

• Leading large client engagements that connect operations strategy, process design, and technology execution to improve efficiency, cost control, and member experience

• Managing workstreams focused on platform transformation across payer systems such as Oracle OHI, Epic, Facets, and Nasco

• Developing current-state and future-state operating models for payer front and middle office functions, with attention to service delivery, controls, and scalability

• Guiding process improvement efforts by analyzing workflows, identifying performance gaps, and redesigning operating procedures

• Coordinating stakeholder discussions across business, technology, and risk groups to align priorities and resolve issues affecting delivery

• Applying business performance metrics and data analysis to evaluate operating effectiveness, track progress, and inform recommendations

• Coaching teams through complex project tasks, setting clear expectations, and supporting issue resolution across multiple workstreams

• Contributing to firm growth by shaping client-facing solutions, sharing market insights, and presenting ideas to senior decision makers

What You Must Have

• At least a Bachelor's degree

• At least 78 years of experience

What Sets You Apart

• Preference for at least one of the following fields of study: Accounting, Actuarial Science, Analytics/Data Science, Business Administration/Management, Computer Science/Information Systems, Economics, Engineering, Finance, Government/Public Policy, Health Administration/Public Health, Mathematics/Statistics, Operations/Supply Chain, Organizational Management/Behavior, Risk Management/Insurance

• Bringing prior consulting experience across payer operations or technology modernization

• Demonstrating experience leading client-facing transformation programs within health services

• Applying operational excellence, process improvement, and performance metric analysis

• Navigating technology, operations, and middle office integration in complex settings

• Communicating strategic recommendations to senior stakeholders with clarity and confidence

The salary range for this position is: $124,000 - $280,000. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. All hired individuals are eligible for an annual discretionary bonus. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glance

As PwC is an equal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law.

PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.

Learn more about how we work: https://pwc.to/how-we-work

For only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all.

Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines: https://pwc.to/us-application-deadlines