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)

Bachelors degree

Degree Preferred

Bachelors degree

Required Field(s) of Study (BQ)

Any Graduate

Preferred Field(s) of Study

Any Graduate

Minimum Year(s) of Experience (BQ) US

5+ years of experience (Payor side of business)

Certification(s) Preferred

AHM 250 (Added advantage)

Preferred Knowledge/Skills

Team Management and Leadership

Insurance and Payer Relations

Handle escalated insurance claim issues and complex payer inquiries, providing expertise and assistance to team members. Develop and maintain relationships with insurance company representatives to expedite claim processing and resolve payment delays. Stay informed about changes in insurance policies, billing guidelines, and reimbursement regulations.

Process Improvement and Training

Identify opportunities for process enhancements and workflow optimization within the A&G function. Develop and deliver training programs to equip team members with the skills and knowledge necessary to excel in their roles. Implement best practices and standard operating procedures to drive operational efficiency and quality outcomes.

Reporting and Analysis

Generate regular reports on team performance metrics, KPIs, and key trends. Analyze data to identify areas of improvement, implement corrective actions, and track progress towards goals.