Are you an experienced professional with health plan and core administration experience? Do you have a penchant for detail with leadership experience? Are you a resourceful problem solver that thrives in the identification and definition of creative, effective solutions? As a Digital Health Plan Senior Consultant, you will help clients set up, manage, and operate their most complex programs, assess and implement core administration solutions, and design and derive transformative approaches for health plan systems and processes.
Work you'll do
Senior Consultants are professionals with strong records of academic and professional achievement who have the capacity and desire for continuous development and growth. Deloitte Consulting professionals must also be capable of working and communicating with people at all levels of an organization. Responsibilities typical of a senior consultant on one of our Digital Health Plan projects could include: • Provide expertise in core administration platforms and health plan functions • Assess a client's current core administration capabilities, define desired future state, identify gaps, and propose potential solutions • Analyze available core administration platforms and provide recommended options based on a client's business and technical needs • Lead project management activities for one or more work streams throughout the implementation of a third-party core administration vendor platform • Gather client requirements and develop clear configuration designs for clients based on their current business needs and their future business requirements • Drive conversion efforts to migrate core business data (e.g., providers, members, claims) from a client's legacy system to a new platform • Partner with one or more business areas to identify impacts, define requirements, design new processes, and implement changes needed for future activities • Assist client with the identification, prioritization, coordination, and resolution of issues among various business areas and third-party vendors that impact production and quality of system implementation efforts
Engagement delivery: • Participate in setting engagement objectives and scope • Assume accountability for on-time delivery of assigned activities and deliverables • Manage delivery, work plans, and activities for one or more work streams • Assess, design, and implement solutions to achieve client's strategic objectives and business issues • Conduct client interviews and facilitate client meetings • Develop process flows depicting pain points in the business process • Conduct detailed analyses to draw conclusions, and develop pertinent and insightful recommendations • Present findings and recommendations to clients • Develop and maintain trusted relationships with client counterparts • Identify and mitigate risks related to one or more work streams
People development: • Mentor and develop junior staff • Actively participate in staff recruitment and retention activities • Provide input and guidance into the staffing process • Provide real-time feedback to project team members and participate in the performance review process • Provide guidance to junior practitioners as they manage large, confidential, and complex data sets
Eminence and firm activities: • Contribute to points of view in health care • Participate in practice development activities within the firm • Lead and support recruitment activities • Organize local office events to build firm culture
The team - Health Care
The Health Care team focuses on assisting those organizations that are responsible for the delivery, funding, and payment management of health care and medical related services. Clients include hospitals, academic medical centers, health systems, home health agencies, long term care, outpatient facilities, ambulatory surgery centers, practitioners and physician groups as well as health plans, other health insurance companies, and pharmacy benefit managers (PBMs).
Health plans face a number of unique environmental pressures that affect the way they will conduct business today and in the future - among them a need for increased privacy and security, an intense focus on risk management, access to capital, efforts to consolidate and streamline IT functions, the launch of new consumer-driven business models, managing chronic diseases through medical management practices, maximizing e-business-driven platforms, implementing health plan-specific customer relationship management tools, and complying with increasing financial and transactional legislation. Our health care professionals can help clients address these and other challenges in today's complex health care environment.
About our Digital Health Plan practice
Our Digital Health Plan practice sits within Core Industry Solutions under Core Business Operations, which supports design, implementation, and operation of "heart of the business" transactional systems and core operations. Core Industry Solutions encompasses industry vertical, sector specific solutions that leverage distinct technologies to drive operational change and automate the core our client's business. We incorporate expertise from across the firm to leverage common approaches, best practices, and strategic investments to scale these solutions according to industry strategy. Professionals focus on key client issues that are at the core of the business by integrating our industry expertise with deep technical and operational transformation capabilities.
The Digital Health Plan practice is focused on accelerated transformation of "heart of the business" operations for health plans through industry technology solutions. Practitioners focus on digital enablement across the health plan value chain, working with health care leaders and organizations to tailor a successful approach for transforming core administration operations and design solutions that meet our their financial, operational, and performance improvement goals. We connect with industry solutions players in the market, incubate new solutions in collaboration with clients and strategic alliances, and scale industry solutions using package and in-house products.
Qualifications
Required:
• Bachelor's degree or equivalent number of years of related work experience • Minimum of 4+ years of professional experience within the health care industry, specifically focused on health insurance core administration functions and platforms • Experience in one or more of the following types of projects within health plans: core administration platform implementation / migration, operational and/or IT solution design, operational and/or IT impact assessment, system evaluation and selection, application rationalization • Demonstrated understanding of the health insurance business (Commercial (Employer and Individual), Medicare, Medicaid, Federal Employee Program, HealthCare Exchanges), with expertise in one or more of the following functional areas: membership and enrollment, billing, claims and claim payables, products and benefits, provider services, provider networks, provider reimbursement methodologies, authorizations, utilization management, care management, customer service • Proficient in Microsoft Office (PowerPoint, Excel, Word) • Proven critical thinking, analytical, and problem-solving skills on business and technical constructs • SDLC management experience in waterfall, agile, and/or scaled agile • Ability to travel up to 50% (While 50% of travel is a requirement of the role, due to COVID-19, non-essential travel has been suspended until further notice.) • Limited immigration sponsorship may be available
Preferred:
• Advanced degree in business, technology, or health care related field from a top tier program • Management consulting experience in a health care related field • Strong leadership and management skills • Understanding of the health care industry, including market landscape, regulatory environment, and industry trends • Experience, training, and/or certification in one or more core administration platforms, such as HealthEdge HealthRules Payor, Facets, QNXT, Oracle Health Insurance Solutions, Epic Tapestry, AMISYS • Experience working on provider data migration initiatives • Experience configuring benefits, providers, contracts, and/or other health plan functions • Exceptional interpersonal, team-building, and communication skills • Commitment to personal and professional growth • Sense of responsibility to self, team, and client • Outstanding integrity, initiative, creativity, and passion • Record of consistent career progression with increasing levels of responsibility • Proactive and open to learning new technologies • Strong work ethic; comfortable working in a fast-paced environment
