Managed Services

A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Appeals and Grievances Managed Services (AGMS) team will provide you with the opportunity to act as an extension of our healthcare clients business office. We specialize in appeal and grievances functions and addressing member complaints for health plans and their business partners. We leverage our clients customized workflows and associated automations in conjunction with PwC s data advanced data analysis and quality assurance processes to enable our clients to achieve better compliant results, which ultimately allows them to provide better services to their members.

Minimum Degree Required (BQ)

Bachelor s Degree

Degree Preferred

Bachelor s Degree

Required Field(s) of Study (BQ)

Any Graduate

Preferred Field(s) of Study

Any Graduate

Minimum Year(s) of Experience (BQ)

3 +years of Payer side experience

Certification(s) Preferred

NA

Required Knowledge/Skills (BQ)

Preferred Knowledge/Skills

The quality control analyst conducts quality control audits of Medicare Appeals and Grievance(A&G) and assures company and client standards are maintained and the integrity of client services are preserved. The Quality Control Analyst will perform a variety of functions including, but not limited to reviewing and monitoring accounts, identifying problems, analyzing trends and suggesting recommendations for improvements. This role consults with and takes direction from the Continuous Improvement Specialist to resolve quality and efficiency issues that may occur on any given project.

Responsibilities

Required Knowledge and Skills