A career in our Benefits practice, within People and Organisation Consulting services, will provide you with the opportunity to help our clients reset their talent strategies and deliver extraordinary business results through their people. We focus on evaluating and managing their unique challenges so our clients can maximise their return on the overall investment in human capital. You’ll gain a tremendous depth of expertise in all aspects of human capital, including creating sustainable value through people culture and change, designing compensation and retirement strategies, and improving human capital operations. Our team helps our clients evaluate, redesign, implement and manage their health and welfare and retirement benefits programmes. You’ll help our clients with active and retiree plan performance management, vendor selection, provider strategy, financial reporting and cost driver analysis, private exchange and drug benefit evaluation.
To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.
As a Senior Associate, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to:
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Use feedback and reflection to develop self awareness, personal strengths and address development areas.
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Delegate to others to provide stretch opportunities, coaching them to deliver results.
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Demonstrate critical thinking and the ability to bring order to unstructured problems.
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Use a broad range of tools and techniques to extract insights from current industry or sector trends.
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Review your work and that of others for quality, accuracy and relevance.
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Know how and when to use tools available for a given situation and can explain the reasons for this choice.
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Seek and embrace opportunities which give exposure to different situations, environments and perspectives.
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Use straightforward communication, in a structured way, when influencing and connecting with others.
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Able to read situations and modify behavior to build quality relationships.
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Uphold the firm's code of ethics and business conduct.
As a PwC Healthcare Consultant, you will be part of our exciting growing team that provides strategic, analytic and technical support to our employer clients. The healthcare landscape has fundamentally transformed over the last 5 years and as such, our clients look to us to support them in redefining their benefit strategy in line with their people strategy, to enhance the employee experience and to achieve operational efficiency.
Job Requirements and Preferences:
Basic Qualifications:
Minimum Degree Required:
Bachelor Degree
Minimum Years of Experience:
3 year(s) with a minimum of 5+ years’ experience in health claims adjudication and administration in a consulting environment and/or in a major insurance carrier or health plan environment.
Preferred Qualifications:
Preferred Fields of Study:
Financial Mathematics, Mathematical Economics, Mathematical Statistics, Mathematics, Public Policy Analysis, Banking and Insurance, Health Administration, Economics and Finance, Business Administration/Management, Business Studies
Preferred Knowledge/Skills:
Demonstrates thorough abilities and/or a proven record of success in roles leading projects involving health and welfare benefits of employer programs and issues in a major consulting firm or at a health plan, in areas that include health plan claims assessments, operational assessments and data analysis.
Demonstrates thorough abilities and/or proven record of success with:
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Understanding of health and welfare plan designs for Commercial, Medicare and Medicaid and various plan types, ACO, HDHP, HMO, EPO, PPO, Indemnity, Medicare Advantage and Managed Care;
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Applying a high level of claims administration knowledge, including experience with medical, dental, mental health, life and disability;
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Leveraging knowledge of claims administration, as well as of vendors’ claims processing systems, processes and operations;
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Utilizing knowledge of ICD-10, CPT and HCPCS codes and coding protocols;
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Communicating in an organized and knowledgeable manner in written and verbal formats;
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Working collaboratively as a team player while exhibiting exceptional work ethic;
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Possessing previous internal audit experience at a carrier or third-party external audit experience;
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Communicating findings to management, vendor and clients;
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Developing client ready deliverables with key recommendations;
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Serving as a Subject Matter Expert to support internal teams;
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Possessing Experience with overseeing sample selection requirements;
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Remaining current with evolving industry and regulatory changes impacting Health and Welfare plans; and,
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Having proficiency in Microsoft Office, including Excel.
At PwC, our work model includes three ways of working: virtual, in-person, and flex (a hybrid of in-person and virtual). Visit the following link to learn more: https://pwc.to/ways-we-work.
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.
All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer.
For positions in Albany (NY), California, Colorado, Nevada, New York City, Washington State, or Westchester County (NY), please visit the following link for pay range information: https://pwc.to/payrange-v1-advisoryseniorassociate
