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2649 PwC Jobs
Managed Services
3-6 years
Hyderabad / Secunderabad
1 vacancy
Managed Services
PwC
posted 17d ago
Job Role Insights
Flexible timing
Key skills for the job
Job Description
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 Graduation
Preferred Field(s) of Study
Minimum Year(s) of Experience (BQ) US
3+ years of experience
Certification(s) Preferred
Required Knowledge/Skills (BQ)
- US Healthcare Experience
- Experience in Appeals & Grievances (A&G, Medicare/Medicaid)
Preferred Knowledge/Skills
- Strong verbal and written communication skills, including letter writing experience.
- Excellent English skills with the ability to read, comprehend, write and communicate verbally with stakeholders & customers.
- Ability to work with firm deadlines, multitask, set priorities and pay attention to details
- Ability to successfully interact with members, medical professionals, health plan and government representatives.
- Knowledge on Appeals & Grievances and Medicare/Medicaid
- Proficiency with Microsoft Word, Excel, and PowerPoint.
- Excellent organizational, interpersonal and time management skills.
- Must be detailoriented and an enthusiastic team player.
- Knowledge of Pega computer system a plus.
- Preferred experience with appeals and grievances
- Provide immediate assistance to specialist and frontline teams for efficient resolution of Appeals & Grievances (A&G) cases.
- Ensure all case resolutions comply with Medicare/Medicaid and other relevant regulations.
- Assist in delivering training sessions and maintaining uptodate process documentation to enhance team capabilities and performance.
- Work closely with Quality Assurance (QA) teams to ensure accuracy and quality in case handling.
- Conduct thorough root cause analysis on recurring issues within A&G processes and work with the team to implement effective corrective actions.
- Monitor and report on key performance indicators to assess the effectiveness of processes and identify areas for improvement.
- Actively seek and incorporate feedback from team members and stakeholders to drive continuous improvement in A&G processes.
- Collaborate with operations and client delivery teams to ensure seamless integration of A&G processes with overall business operations, enhancing client satisfaction.
- Monitor and identify trends in denials and grievances, escalating important findings to appropriate authorities for action.
- Support audit preparations by ensuring comprehensive and compliant case documentation.
- Collaborate with claims, customer service, and provider relations teams to refine and enhance case resolution processes.
- Identify potential areas for automation within A&G processes and encourage specialists to propose solutions that enhance efficiency and effectiveness.
- Keep knowledge bases and Standard Operating Procedures (SOPs) updated to assist in training and development initiatives.
- Interface with health plan Claims, Utilization Management, Network Management, and Call Center professionals, as well as communicate with health plan members and providers, to gather information necessary for case resolution.
- Work with Managers, QA Specialists, and A&G Trainers to enhance team productivity, engagement quality, and maintain positive employee relations.
Required Knowledge and Skills
- Able to document problems and assist in their resolution.
- Operational managed care experience (call center, appeals or claims environment).
- Health claims processing background, including A&G, coordination of benefits, subrogation, and eligibility criteria.
- Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.
- Demonstrated ability exceeding all established department/client quality and productivity standards.
- Proven ability to lead by example and foster mentoring relationships.
- Strong written and oral communication skills.
- Computer and internet literate in an MS Office environment; and,
- Ability to establish and maintain effective working relationships.
- US Healthcare Medicare and Medicaid Insurance Claim Management/Billing/Claim Edit Resolution
- Experience Level 3+ years.
- Shift timings Flexible to work in night shifts (US Time zone)
- Preferred Qualification Bachelor s degree in finance or Any Graduate
Employment Type: Full Time, Permanent
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What people at PwC are saying
Rating based on 446 Manager
reviews
Anonymous · Engineering - Software & QA
in Hyderabad / Secunderabad
Likes
Compensation is competitive to the market
- Salary - Good
+2 more
Dislikes
No work life balance.. all projects planned eith very limited resources and tight timelines forcing team members to extend personal time gor work
- Work-life balance - Bad
Manager salary at PwC
reported by
6.8k
employees
with 4-18
years exp.
₹14
L/yr - ₹45
L/yr
86%
more
than the average Manager Salary in India
View more details
What PwC employees are saying about work life
based on 9.2k employees
Flexible timing
Monday to Friday
No travel
Day Shift
PwC Benefits
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Staff discounts Professional Memberships In-house learning tools Referral Bonuses Corporate Plan
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